Provider Demographics
NPI:1235515529
Name:PROSYNERGY PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:PROSYNERGY PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:AGNIESZKA
Authorized Official - Middle Name:
Authorized Official - Last Name:MIKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-583-4391
Mailing Address - Street 1:62 NEWELL DR
Mailing Address - Street 2:
Mailing Address - City:BASKING RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07920-2510
Mailing Address - Country:US
Mailing Address - Phone:908-583-4391
Mailing Address - Fax:
Practice Address - Street 1:45 SOUTH AVE W
Practice Address - Street 2:
Practice Address - City:CRANFORD
Practice Address - State:NJ
Practice Address - Zip Code:07016-2686
Practice Address - Country:US
Practice Address - Phone:908-583-4391
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-10
Last Update Date:2015-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01486500225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty