# SPINE & SPORTS MEDICINE OF LINCROFT, LLC

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

## Provider details

- **NPI number:** 1649832197
- **Authorized official:** NICOLE FULLAWAY PT, DPT (DIRECTOR)
- **Authorized official phone:** (732) 714-0070

## Contact information

- **Practice address:** 5 SWIMMING RIVER RD, LINCROFT, NJ 07738-1725
- **Practice address phone:** (324) 514-5787
- **Practice address fax:** (732) 530-3561
- **Mailing address:** 3 SWIMMING RIVER RD, LINCROFT, NJ 07738-1725
- **Mailing address phone:** (732) 653-1000

## Taxonomy

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

## Other

- **Enumeration date:** 07/05/2019
- **Last updated:** 05/02/2024