Provider Demographics
NPI:1902801475
Name:SURE REHAB
Entity Type:Organization
Organization Name:SURE REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:SAY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:609-494-0020
Mailing Address - Street 1:PO BOX 223
Mailing Address - Street 2:
Mailing Address - City:SHIP BOTTOM
Mailing Address - State:NJ
Mailing Address - Zip Code:08008-0235
Mailing Address - Country:US
Mailing Address - Phone:609-494-0020
Mailing Address - Fax:
Practice Address - Street 1:1702 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:BARNEGAT LIGHT
Practice Address - State:NJ
Practice Address - Zip Code:08006
Practice Address - Country:US
Practice Address - Phone:609-494-0020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJQA3833225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ068051Medicare ID - Type Unspecified