Organization
SPINE & SPORTS MEDICINE OF TINTON FALLS LLC
Active
Organization
SPINE & SPORTS MEDICINE OF TINTON FALLS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NICOLE FULLAWAY DPT (OWNER)
(609) 505-9090
Entity
Organization
Contact information
Practice address
4057 ASBURY AVE STE 4, TINTON FALLS, NJ 07753-7700
(732) 333-3099
(848) 217-7463
Mailing address
4057 ASBURY AVE, STORE #4, TINTON FALLS, NJ 07753-7700
(732) 333-3099
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
—
—
171100000X
Acupuncturist
—
—
207X00000X
Orthopaedic Surgery Physician
—
—
208100000X
Physical Medicine & Rehabilitation Physician
—
—
208VP0014X
Interventional Pain Medicine Physician
Primary
—
—
225100000X
Physical Therapist
—
—
Other
Enumeration date
09/13/2017
Last updated
05/09/2024
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