Provider Demographics
NPI:1679971931
Name:REGAIN PHYSICAL THERAPY, LLC
Entity type:Organization
Organization Name:REGAIN PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMIREZ
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:973-517-6501
Mailing Address - Street 1:140 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07109-1925
Mailing Address - Country:US
Mailing Address - Phone:973-302-7092
Mailing Address - Fax:973-528-2322
Practice Address - Street 1:5600 KENNEDY BLVD W
Practice Address - Street 2:SUITE 200
Practice Address - City:WEST NEW YORK
Practice Address - State:NJ
Practice Address - Zip Code:07093-1256
Practice Address - Country:US
Practice Address - Phone:201-662-7612
Practice Address - Fax:201-662-7614
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-18
Last Update Date:2015-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01192600261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy