Authentic Physical Therapy LLC

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

Legal business name

AUTHENTIC PHYSICAL THERAPY LLC

Practice address

265 W Grand St
Elizabeth, NJ 07202-1205

Phone

(201) 256-3623

Fax

(201) 256-3632

NPI assigned

Jun 12, 2025

Last updated

Jul 23, 2025By 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

Tati B Harsono, PTNPI 1407152622

Title

Physical Therapist

Phone

(201) 256-3623

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NJ

Enrollment records 1

Locations

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.

• Tati B Harsono, P.T.

  • Physical Therapist
  • Farmingdale, NY
  • NPI 1407152622

  NJ

  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1749686400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1753228800000",
    "number": "1245125723",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "265 W GRAND ST",
            "city": "ELIZABETH",
            "state": "NJ",
            "postal_code": "072021205",
            "telephone_number": "201-256-3623",
            "fax_number": "201-256-3632"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "265 W GRAND ST",
            "city": "ELIZABETH",
            "state": "NJ",
            "postal_code": "072021205",
            "telephone_number": "201-256-3623",
            "fax_number": "201-256-3632"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AUTHENTIC PHYSICAL THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-06-12",
        "last_updated": "2025-07-23",
        "certification_date": "2025-07-23",
        "status": "A",
        "authorized_official_last_name": "HARSONO",
        "authorized_official_first_name": "TATI",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "201-256-3623",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physical Therapy Clinic/Center in Elizabeth, NJ
• Providers in Elizabeth, NJ by specialty
• Physical Therapy Clinic/Center in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2025; 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.