Altius Physical Therapy LLC

Organization Active NPI Physical Therapy Clinic/Center · Park Ridge, NJ

NPI 1124751748 · NPPES record last updated Oct 3, 2022

Key facts

NPI: 1124751748
Entity type: Organization (NPI type 2)
Primary specialty: Physical Therapy Clinic/Center 261QP2000X
Legal business name: ALTIUS PHYSICAL THERAPY LLC
Practice address: 52 Park Ave Ste A4
Park Ridge, NJ 07656-1277
Phone: (845) 548-1641
NPI assigned: Jul 1, 2022
Organization subpart: No

Authorized official

Name: Evan Bracconeri, DPT NPI 1912253683
Title: Owner
Phone: (845) 548-1641

Authorized official NPPES reports the authorized official by name only; the link goes to the one practitioner connected to this organization with that name.

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Evan Bracconeri, DPT Physical Therapist · New York, NY · NPI 1912253683

Medicare reassignment NPD Authorized official NJ · PHYSICAL THERAPIST

Medicare participation

Medicare fee-for-service enrollment: Enrolled in NJ

Medicare enrollment records

Enrollment ID	State	Provider type	PAC ID	Details
O20230204000477	NJ	Part B Supplier - Physical/Occupational Therapy Group in Private Practice	2769851807	Receives reassigned benefits from 1 practitioner Practice locations: Park Ridge, NJ

National Provider Directory

Locations

52 Park Ave
Ste A4
Park Ridge, NJ 07656
Phone (201) 391-8932

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Physical Therapy Clinic/Center	261QP2000X			Yes

Addresses

Primary practice location

52 Park Ave Ste A4
Park Ridge, NJ 07656-1277

Mailing address

769 Drake LN
River Vale, NJ 07675-6115
Phone (845) 548-1641

Other providers in Park Ridge, NJ

All providers in Park Ridge, NJ · Physical Therapy Clinic/Center in New Jersey

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 3, 2022. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
Medicare Fee-For-Service Public Provider 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.