Jag-One Physical Therapy, LLC

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

Legal business name

JAG-ONE PHYSICAL THERAPY, LLC

Practice address

34 Mountain Blvd BLDG C
Warren, NJ 07059-2640

Phone

(908) 222-0515

Fax

(908) 222-0516

NPI assigned

Dec 10, 2018

Organization subpart

No

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

Authorized official

Name

Luann M Teetsell

Title

Credentialing Manager

Phone

(718) 844-5350

Specialties & licenses 2

Addresses

Other names 1

• Jag Physical Therapy LLC Former legal business name

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

{
    "created_epoch": "1544400000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1565049600000",
    "number": "1477024941",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 ROUTE 9 N",
            "city": "WOODBRIDGE",
            "state": "NJ",
            "postal_code": "070951025",
            "telephone_number": "201-801-7141"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "34 MOUNTAIN BLVD BLDG C",
            "city": "WARREN",
            "state": "NJ",
            "postal_code": "070592640",
            "telephone_number": "908-222-0515",
            "fax_number": "908-222-0516"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JAG-ONE PHYSICAL THERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-12-10",
        "last_updated": "2019-08-06",
        "status": "A",
        "authorized_official_last_name": "TEETSELL",
        "authorized_official_first_name": "LUANN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "718-844-5350"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jag Physical Therapy LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• Occupational Therapist in Warren, NJ
• Providers in Warren, NJ by specialty
• Occupational Therapist in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2019; 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.