Professional Sports & Orthopaedic Rehabilitation Associates, LLC

Primary specialty

Physical TherapistTaxonomy code 225100000X

Legal business name

PROFESSIONAL SPORTS & ORTHOPAEDIC REHABILITATION ASSOCIATES, LLC

Practice address

455 US Highway 9
Co Game Shape
Manalapan, NJ 07726-8274

Phone

(732) 617-8090

Fax

(732) 972-5458

NPI assigned

Feb 5, 2007

Organization subpart

No

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

Authorized official

Name

Miss Michelle E. Wolpov, PT

Title

Owner Diretor

Phone

(732) 617-8090

Specialties & licenses 1

Addresses

Other identifiers 5

Locations

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

{
    "created_epoch": "1170633600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1344902400000",
    "number": "1497894968",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "455 US HIGHWAY 9",
            "address_2": "CO GAME SHAPE",
            "city": "MANALAPAN",
            "state": "NJ",
            "postal_code": "077268274",
            "telephone_number": "732-617-8090",
            "fax_number": "732-972-5458"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "455 US HIGHWAY 9",
            "address_2": "CO GAME SHAPE",
            "city": "MANALAPAN",
            "state": "NJ",
            "postal_code": "077268274",
            "telephone_number": "732-617-8090",
            "fax_number": "732-972-5458"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROFESSIONAL SPORTS & ORTHOPAEDIC REHABILITATION ASSOCIATES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-05",
        "last_updated": "2012-08-14",
        "status": "A",
        "authorized_official_last_name": "WOLPOV",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_middle_name": "E.",
        "authorized_official_title_or_position": "OWNER DIRETOR",
        "authorized_official_telephone_number": "732-617-8090",
        "authorized_official_name_prefix": "Miss",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA ID NUMBER",
            "identifier": "2854674",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHNET",
            "identifier": "3K4277",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ORTHONET-AETNA",
            "identifier": "0218901",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ORTHONET-HEALTHNET",
            "identifier": "0109001",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OXFORD",
            "identifier": "P2650341",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Physical Therapist in Manalapan, NJ
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• Physical Therapist in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2012; 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.