Provider Demographics
NPI:1730830571
Name:CC PHYSICAL THERAPY AND WELLNESS, LLC
Entity type:Organization
Organization Name:CC PHYSICAL THERAPY AND WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CORTNEY
Authorized Official - Middle Name:CATHERINE
Authorized Official - Last Name:RILEY
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, CSCS
Authorized Official - Phone:908-419-2932
Mailing Address - Street 1:PO BOX 332
Mailing Address - Street 2:
Mailing Address - City:GLADSTONE
Mailing Address - State:NJ
Mailing Address - Zip Code:07934-0332
Mailing Address - Country:US
Mailing Address - Phone:908-419-2932
Mailing Address - Fax:
Practice Address - Street 1:1806 SPRINGFIELD AVE STE 1
Practice Address - Street 2:
Practice Address - City:NEW PROVIDENCE
Practice Address - State:NJ
Practice Address - Zip Code:07974-1005
Practice Address - Country:US
Practice Address - Phone:908-771-0707
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-13
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty