MEDICARE: PC REHABILITATION MEDICINE AND PHYSICAL THERAPY, P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2251E1300X	Clinical Electrophysiology Physical Therapist

General Provider Information

NPI Number	:	1144267402
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PC REHABILITATION MEDICINE AND PHYSICAL THERAPY, P.A.

Provider Business Mailing Address
First Line	:	960 PLEASANT VALLEY WAY
Second Line	:
City	:	WEST ORANGE
State	:	NJ
Zip	:	07052-1803
Country	:	US
Telephone Number	:	973-243-1177
Fax Number	:	973-243-9077

Provider Business Practice Location Address
First Line	:	960 PLEASANT VALLEY WAY
Second Line	:
City	:	WEST ORANGE
State	:	NJ
Zip	:	07052-1803
Country	:	US
Telephone Number	:	973-243-1177
Fax Number	:	973-243-9077

Authorized Official
Title or Position	:	CO-DIRECTOR
Name	:	DR. THOMAS J. CAVA
Credential	:	M.D.
Telephone Number	:	973-243-1177

Provider Enumeration Date	:	06/02/2006
Last Update Date	:	08/22/2020

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