Basic Information
| Provider Information | |||||||||
| NPI: | 1841245677 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MCRC PHYSICAL THERAPY, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 161 MILLBURN AVE | ||||||||
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| City: | MILLBURN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070411825 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7327395545 | ||||||||
| FaxNumber: | 7327395547 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 BETHANY RD | ||||||||
| Address2: | BUILDING 2, SUITE 27 | ||||||||
| City: | HAZLET | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 077301663 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7327395545 | ||||||||
| FaxNumber: | 7327395547 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | O'NEILL | ||||||||
| AuthorizedOfficialFirstName: | JAMIE | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR OF OPERATIONS | ||||||||
| AuthorizedOfficialTelephone: | 9733767100 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.