# SPINE & SPORTS MEDICINE OF TOMS RIVER, LLC

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

## Provider details

- **NPI number:** 1649761883
- **Authorized official:** NICOLE FULLAWAY DPT (PARTNER)
- **Authorized official phone:** (732) 714-0070

## Contact information

- **Practice address:** 367 LAKEHURST RD, TOMS RIVER, NJ 08755
- **Practice address phone:** (732) 573-6235
- **Practice address fax:** (732) 504-7676
- **Mailing address:** 367 LAKEHURST RD, TOMS RIVER, NJ 08755-7330
- **Mailing address phone:** (732) 714-0070

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 111N00000X | Chiropractor | — | NULL | — |
| 111N00000X | Chiropractor | — | — | — |
| 171100000X | Acupuncturist | — | NULL | — |
| 171100000X | Acupuncturist | — | — | — |
| 207X00000X | Orthopaedic Surgery Physician | — | NULL | — |
| 207X00000X | Orthopaedic Surgery Physician | — | — | — |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | NULL | Yes |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | — | Yes |
| 225100000X | Physical Therapist | — | NULL | — |
| 225100000X | Physical Therapist | — | — | — |

## Other

- **Enumeration date:** 05/23/2018
- **Last updated:** 05/09/2024