Healthcare Provider Details

I. General information

NPI: 1073989539
Provider Name (Legal Business Name): REBECCA GOLD KASHDAN PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2015
Last Update Date: 08/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1278 YARDVILLE ALLENTOWN RD
ALLENTOWN NJ
08501-1866
US

IV. Provider business mailing address

21 CLARENCE AVE
LONG BRANCH NJ
07740-4818
US

V. Phone/Fax

Practice location:
  • Phone: 609-738-3143
  • Fax:
Mailing address:
  • Phone: 732-927-0796
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA01620800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: