Provider Demographics
NPI:1447309299
Name:SPECTRUM PHYSICAL REHABILITATION & THERAPY , LLC
Entity type:Organization
Organization Name:SPECTRUM PHYSICAL REHABILITATION & THERAPY , LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:F
Authorized Official - Last Name:CARLUCCI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:732-370-5800
Mailing Address - Street 1:2105 W COUNTY LINE RD
Mailing Address - Street 2:SUITE 7
Mailing Address - City:JACKSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08527-2301
Mailing Address - Country:US
Mailing Address - Phone:732-370-5800
Mailing Address - Fax:732-370-6772
Practice Address - Street 1:2105 W COUNTY LINE RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:NJ
Practice Address - Zip Code:08527-2301
Practice Address - Country:US
Practice Address - Phone:732-370-5800
Practice Address - Fax:732-370-6772
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00350200111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty