Activity First Physical Therapy and Sports Medicine

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

40QA00616100 Issued in NJ

Legal business name

ACTIVITY FIRST PHYSICAL THERAPY AND SPORTS MEDICINE

Practice address

158 Wyckoff Rd
Eatontown, NJ 07724-1840

Phone

(732) 544-0007

Fax

(732) 544-0008

NPI assigned

Oct 17, 2006

Last updated

Mar 11, 2014By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Kevin Luis Gonzalez, P.T.NPI 1225068158

Title

Owner

Phone

(732) 544-0007

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NJ

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Kevin Luis Gonzalez, PT

  • Physical Therapist
  • Eatontown, NJ
  • NPI 1225068158
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161043200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1394496000000",
    "number": "1124108782",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "158 WYCKOFF RD",
            "city": "EATONTOWN",
            "state": "NJ",
            "postal_code": "077241840",
            "telephone_number": "732-544-0007",
            "fax_number": "732-544-0008"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "158 WYCKOFF RD",
            "city": "EATONTOWN",
            "state": "NJ",
            "postal_code": "077241840",
            "telephone_number": "732-544-0007",
            "fax_number": "732-544-0008"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ACTIVITY FIRST PHYSICAL THERAPY AND SPORTS MEDICINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-17",
        "last_updated": "2014-03-11",
        "status": "A",
        "authorized_official_last_name": "GONZALEZ",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_middle_name": "LUIS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "732-544-0007",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "P.T."
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NJ",
            "license": "40QA00616100",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physical Therapist in Eatontown, NJ
• Providers in Eatontown, NJ by specialty
• Physical Therapist in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.