Provider Demographics
NPI:1053948489
Name:CREST PHYSICAL THERAPY SERVICES
Entity type:Organization
Organization Name:CREST PHYSICAL THERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:CALABRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-212-0060
Mailing Address - Street 1:3 EXECUTIVE DR STE 400
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-4007
Mailing Address - Country:US
Mailing Address - Phone:732-369-5994
Mailing Address - Fax:
Practice Address - Street 1:100 STATE ROUTE 36 STE 2P
Practice Address - Street 2:
Practice Address - City:WEST LONG BRANCH
Practice Address - State:NJ
Practice Address - Zip Code:07764-1453
Practice Address - Country:US
Practice Address - Phone:732-741-1119
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-25
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty