Provider Demographics
NPI:1679871214
Name:ADVANCED SPORTS AND SPINE REHAB, LLC
Entity type:Organization
Organization Name:ADVANCED SPORTS AND SPINE REHAB, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DC
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:ALEPA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-664-9200
Mailing Address - Street 1:806 ROUTE 17 N
Mailing Address - Street 2:
Mailing Address - City:RAMSEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07446-1608
Mailing Address - Country:US
Mailing Address - Phone:201-664-9200
Mailing Address - Fax:
Practice Address - Street 1:806 ROUTE 17 N
Practice Address - Street 2:
Practice Address - City:RAMSEY
Practice Address - State:NJ
Practice Address - Zip Code:07446-1608
Practice Address - Country:US
Practice Address - Phone:201-664-9200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-07
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty