MEDICARE: PHYSICAL THERAPY DOCTOR NJ, PC

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	:	1821677956
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHYSICAL THERAPY DOCTOR NJ, PC

Provider Business Mailing Address
First Line	:	719 N BEERS ST STE 2B
Second Line	:
City	:	HOLMDEL
State	:	NJ
Zip	:	07733-1523
Country	:	US
Telephone Number	:	732-847-9922
Fax Number	:

Provider Business Practice Location Address
First Line	:	719 N BEERS ST STE 2B
Second Line	:
City	:	HOLMDEL
State	:	NJ
Zip	:	07733-1523
Country	:	US
Telephone Number	:	732-847-9922
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	IRINA FOOKSON
Credential	:
Telephone Number	:	732-847-9922

Provider Enumeration Date	:	04/06/2021
Last Update Date	:	04/06/2021

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