Provider Demographics
NPI:1902562994
Name:DRAHOS PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:DRAHOS PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:DRAHOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-355-7872
Mailing Address - Street 1:5 SORMAN TER
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:NJ
Mailing Address - Zip Code:07869-3419
Mailing Address - Country:US
Mailing Address - Phone:973-355-7872
Mailing Address - Fax:
Practice Address - Street 1:5 SORMAN TER
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:NJ
Practice Address - Zip Code:07869-3419
Practice Address - Country:US
Practice Address - Phone:973-355-7872
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-13
Last Update Date:2022-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Single Specialty