Provider Demographics
NPI:1023273414
Name:STAATS PHYSICAL THERAPY, LLC
Entity type:Organization
Organization Name:STAATS PHYSICAL THERAPY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:STAATS
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:732-920-0880
Mailing Address - Street 1:489 BRICK BLVD
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08723-6055
Mailing Address - Country:US
Mailing Address - Phone:732-920-0880
Mailing Address - Fax:732-920-0004
Practice Address - Street 1:489 BRICK BLVD
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08723-6055
Practice Address - Country:US
Practice Address - Phone:732-920-0880
Practice Address - Fax:732-920-0004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-24
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01133700225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ127245Medicare PIN