Healthcare Provider Details

I. General information

NPI: 1730151630
Provider Name (Legal Business Name): PHYSICAL THERAPY CENTER OF WOODBRIDGE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 SAINT GEORGES AVE
AVENEL NJ
07001-1000
US

IV. Provider business mailing address

PO BOX 567
AVENEL NJ
07001-0567
US

V. Phone/Fax

Practice location:
  • Phone: 732-750-9286
  • Fax: 732-750-9225
Mailing address:
  • Phone: 732-750-9286
  • Fax: 732-750-9225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberQA02309
License Number StateNJ

VIII. Authorized Official

Name: MR. RONALD EUGENE SWARD
Title or Position: SEC TRES
Credential:
Phone: 732-750-9286