Provider Demographics
NPI:1871101956
Name:DIAGNOSTIX PHYSICAL THERAPY AND REHABILITATION
Entity type:Organization
Organization Name:DIAGNOSTIX PHYSICAL THERAPY AND REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:D'AMICO
Authorized Official - Suffix:
Authorized Official - Credentials:DPT, COMT
Authorized Official - Phone:201-247-5426
Mailing Address - Street 1:155 VISTA TER
Mailing Address - Street 2:
Mailing Address - City:POMPTON LAKES
Mailing Address - State:NJ
Mailing Address - Zip Code:07442-1476
Mailing Address - Country:US
Mailing Address - Phone:201-247-5426
Mailing Address - Fax:
Practice Address - Street 1:155 VISTA TER
Practice Address - Street 2:
Practice Address - City:POMPTON LAKES
Practice Address - State:NJ
Practice Address - Zip Code:07442-1476
Practice Address - Country:US
Practice Address - Phone:201-247-5426
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-15
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy