Organization
SPINE & SPORTS MEDICINE OF LINCROFT, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NICOLE FULLAWAY PT, DPT (DIRECTOR)
(732) 714-0070
Entity
Organization
Contact information
Practice address
5 SWIMMING RIVER RD, LINCROFT, NJ 07738-1725
(324) 514-5787
(732) 530-3561
Mailing address
3 SWIMMING RIVER RD, LINCROFT, NJ 07738-1725
(732) 653-1000
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
—
—
171100000X
Acupuncturist
—
—
208100000X
Physical Medicine & Rehabilitation Physician
Primary
—
—
225100000X
Physical Therapist
—
—
Other
Enumeration date
07/05/2019
Last updated
05/02/2024
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