Provider Demographics
NPI:1679912257
Name:FRANK FAILLA PHYSICAL THERAPY, LLC
Entity type:Organization
Organization Name:FRANK FAILLA PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DPT
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:FAILLA
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:917-684-9789
Mailing Address - Street 1:15 THE CRESCENT
Mailing Address - Street 2:UNIT 5
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-2664
Mailing Address - Country:US
Mailing Address - Phone:917-684-9789
Mailing Address - Fax:877-642-1441
Practice Address - Street 1:623 LAFAYETTE AVE
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:NJ
Practice Address - Zip Code:07506-2439
Practice Address - Country:US
Practice Address - Phone:917-684-9789
Practice Address - Fax:877-642-1441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-18
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ225100000X
NJ40QA01254100225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty