Provider Demographics
NPI:1538535869
Name:TOTAL CARE PHYSICAL THERAPY & SPORTS MEDICINE PC
Entity type:Organization
Organization Name:TOTAL CARE PHYSICAL THERAPY & SPORTS MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ARTUR
Authorized Official - Middle Name:
Authorized Official - Last Name:MULLOKANDOV
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:917-362-0646
Mailing Address - Street 1:4801 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07087-6516
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4801 BROADWAY
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:NJ
Practice Address - Zip Code:07087-6516
Practice Address - Country:US
Practice Address - Phone:917-362-0646
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-20
Last Update Date:2015-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA014795002251S0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSportsGroup - Multi-Specialty