Basic Information
| Provider Information | |||||||||
| NPI: | 1972881233 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | UNITED SPORTS CARE & PHYSICAL THERAPY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11 EAGLE ROCK AVE STE 201 | ||||||||
| Address2: | |||||||||
| City: | EAST HANOVER | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 079363167 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9738879000 | ||||||||
| FaxNumber: | 9738873816 | ||||||||
| Practice Location | |||||||||
| Address1: | 218 RIDGEDALE AVE | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | CEDAR KNOLLS | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 079272109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9738879000 | ||||||||
| FaxNumber: | 9738873816 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/03/2011 | ||||||||
| LastUpdateDate: | 01/16/2019 | ||||||||
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| AuthorizedOfficialLastName: | LANTIGUA | ||||||||
| AuthorizedOfficialFirstName: | ELIZABETH | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | CONTRACT MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 9739293351 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | N | 193200000X MULTI-SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 225100000X | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225XH1200X | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Hand | 225XP0200X | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Pediatrics | 225X00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.