Provider Demographics
NPI:1689413486
Name:ORTHOPRO PHYSICAL THERAPY NJ LLC
Entity type:Organization
Organization Name:ORTHOPRO PHYSICAL THERAPY NJ LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAYANTS
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, OCS, CMPT
Authorized Official - Phone:973-699-0599
Mailing Address - Street 1:14 FAWN DR
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-1916
Mailing Address - Country:US
Mailing Address - Phone:973-699-0599
Mailing Address - Fax:646-357-3577
Practice Address - Street 1:66 W MOUNT PLEASANT AVE STE 205
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-2930
Practice Address - Country:US
Practice Address - Phone:973-699-0599
Practice Address - Fax:646-357-3577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-21
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty