Provider Demographics
NPI:1144719188
Name:RESURGENCE PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:RESURGENCE PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GOODELL
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:585-322-5434
Mailing Address - Street 1:30 FARRAND ST APT 530
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003-4439
Mailing Address - Country:US
Mailing Address - Phone:585-322-5434
Mailing Address - Fax:
Practice Address - Street 1:561 BLOOMFIELD AVE
Practice Address - Street 2:
Practice Address - City:VERONA
Practice Address - State:NJ
Practice Address - Zip Code:07044-1818
Practice Address - Country:US
Practice Address - Phone:973-744-6279
Practice Address - Fax:973-200-2252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-04
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy