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Organization
PROFESSIONAL SPORTS & ORTHOPAEDIC REHABILITATION ASSOCIATES, LLC
Active
Organization
PROFESSIONAL SPORTS & ORTHOPAEDIC REHABILITATION ASSOCIATES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS MICHELLE E. WOLPOV PT (OWNER DIRETOR)
(732) 617-8090
Entity
Organization
Contact information
Practice address
455 US HIGHWAY 9, CO GAME SHAPE, MANALAPAN, NJ 07726-8274
(732) 617-8090
(732) 972-5458
Mailing address
455 US HIGHWAY 9, CO GAME SHAPE, MANALAPAN, NJ 07726-8274
(732) 617-8090
(732) 972-5458
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0109001
ORTHONET-HEALTHNET
NJ
01
—
0218901
ORTHONET-AETNA
NJ
01
—
2854674
AETNA ID NUMBER
NJ
01
—
3K4277
HEALTHNET
NJ
01
—
P2650341
OXFORD
NJ
Enumeration date
02/05/2007
Last updated
08/14/2012
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