Provider Demographics
NPI:1861247066
Name:TSL SPORT THERAPEUTICS LLC
Entity type:Organization
Organization Name:TSL SPORT THERAPEUTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:R
Authorized Official - Last Name:DISLA
Authorized Official - Suffix:JR
Authorized Official - Credentials:DPT
Authorized Official - Phone:732-858-1777
Mailing Address - Street 1:12 HIGHLAND DR
Mailing Address - Street 2:
Mailing Address - City:MANALAPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726-2708
Mailing Address - Country:US
Mailing Address - Phone:732-858-1777
Mailing Address - Fax:
Practice Address - Street 1:12 HIGHLAND DR
Practice Address - Street 2:
Practice Address - City:MANALAPAN
Practice Address - State:NJ
Practice Address - Zip Code:07726-2708
Practice Address - Country:US
Practice Address - Phone:732-858-1777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-22
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty