MEDICARE: ST MATTHEW PHYSICAL THERAPY AND WELLNESS CENTER LLC

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	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1427638006
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST MATTHEW PHYSICAL THERAPY AND WELLNESS CENTER LLC

Provider Business Mailing Address
First Line	:	277 KENNEDY BLVD
Second Line	:
City	:	BAYONNE
State	:	NJ
Zip	:	07002-1212
Country	:	US
Telephone Number	:	201-688-9702
Fax Number	:

Provider Business Practice Location Address
First Line	:	438B W SIDE AVE
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07304-1426
Country	:	US
Telephone Number	:	201-688-9702
Fax Number	:

Authorized Official
Title or Position	:	PHYSICAL THERAPIST
Name	:	MR. CHRISTOPHER ANDRADA MILLAN
Credential	:
Telephone Number	:	201-688-9702

Provider Enumeration Date	:	04/08/2021
Last Update Date	:	04/08/2021

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