NPIMap

Organization Active NPI

Pro-Activity Rehabilitation Associates, LLC

  • Physical Therapist
  • Lebanon, NJ
National Provider Identifier
1457356735
Registry record updated Dec 3, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
PRO-ACTIVITY REHABILITATION ASSOCIATES, LLC
Practice address
1250 State Route 31
Lebanon, NJ 08833-3238
Phone
(908) 730-6640
Fax
(908) 730-0468
NPI assigned
Jun 14, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 3, 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, DPT
Title
Director of Clinical Operations
Phone
(908) 730-6640

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 Ste 100
Lebanon, NJ 08833-3238
Phone (908) 730-6640

National Provider Directory

National Provider Directory

Locations

1250 State Route 31
Ste 100
Lebanon, NJ 08833

148 Main St
#4
Lebanon, NJ 08833
Phone (908) 730-6640

Practitioners & affiliated clinicians

Practitioners 6

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": "1118707200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1606953600000",
    "number": "1457356735",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1250 STATE ROUTE 31 STE 100",
            "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": "PRO-ACTIVITY REHABILITATION ASSOCIATES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-14",
        "last_updated": "2020-12-03",
        "certification_date": "2020-12-03",
        "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": []
}

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 3, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.