NPIMap

Organization Active NPI

Proactivity Fitness Physical Therapy Associates

  • Physical Therapist
  • Lebanon, NJ
National Provider Identifier
1265038160
Registry record updated Dec 7, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
PROACTIVITY FITNESS PHYSICAL THERAPY ASSOCIATES
Practice address
1250 State Route 31
Lebanon, NJ 08833-3238
Phone
(908) 730-6640
Fax
(908) 730-0468
NPI assigned
Dec 7, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 7, 2020

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

Authorized official

Name
Dr. Justin Scott Bagley, PT, DPTNPI 1982715637
Title
Director of Clinical Operations
Phone
(908) 730-6640

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X Primary

Addresses

Primary practice location

1250 State Route 31
Lebanon, NJ 08833-3238

Mailing address

1250 State Route 31
Lebanon, NJ 08833-3238
Phone (908) 730-6640

Other names 1

  • Pro-Activity Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20201230002449 NJ Part B Supplier - Physical/Occupational Therapy Group in Private Practice 1658784103 Receives reassigned benefits from 4 practitioners
Practice locations: Lebanon, NJ

National Provider Directory

National Provider Directory

Locations

1250 State Route 31
Lebanon, NJ 08833
Phone (833) 766-2281

Practitioners & affiliated clinicians

Practitioners 12

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

NPI Registry JSON

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

{
    "created_epoch": "1607299200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1607299200000",
    "number": "1265038160",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1250 STATE ROUTE 31",
            "city": "LEBANON",
            "state": "NJ",
            "postal_code": "088333238",
            "telephone_number": "908-730-6640",
            "fax_number": "908-730-0468"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1250 STATE ROUTE 31",
            "city": "LEBANON",
            "state": "NJ",
            "postal_code": "088333238",
            "telephone_number": "908-730-6640",
            "fax_number": "908-730-0468"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROACTIVITY FITNESS PHYSICAL THERAPY ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-12-07",
        "last_updated": "2020-12-07",
        "certification_date": "2020-12-07",
        "status": "A",
        "authorized_official_last_name": "BAGLEY",
        "authorized_official_first_name": "JUSTIN",
        "authorized_official_middle_name": "SCOTT",
        "authorized_official_title_or_position": "DIRECTOR OF CLINICAL OPERATIONS",
        "authorized_official_telephone_number": "908-730-6640",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PT, DPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pro-Activity",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lebanon, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2020; 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.