# EDGE PRO SPORTS REHAB INSTITUTE, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1124519160
- **Authorized official:** LAWRENCE KIM DPT (MANAGING DIRECTOR)
- **Authorized official phone:** (201) 783-2332

## Contact information

- **Practice address:** 407 SETTE DR, PARAMUS, NJ 07652
- **Practice address phone:** (201) 538-7131
- **Mailing address:** 80 E RTE 4 STE 100, PARAMUS, NJ 07652-2647
- **Mailing address phone:** (201) 845-3000

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | 40QA01510100 | NJ | Yes |
| 225100000X | Physical Therapist | — | NULL | — |
| 225100000X | Physical Therapist | — | — | — |

## Other

- **Enumeration date:** 05/25/2018
- **Last updated:** 07/19/2021