Healthcare Provider Details

I. General information

NPI: 1750681201
Provider Name (Legal Business Name): RIVERWALK PHYSICAL THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2010
Last Update Date: 05/26/2020
Certification Date: 05/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 MOUNTAINVIEW BLVD STE 207
BASKING RIDGE NJ
07920-3453
US

IV. Provider business mailing address

25 MOUNTAINVIEW BLVD STE 207
BASKING RIDGE NJ
07920-3453
US

V. Phone/Fax

Practice location:
  • Phone: 908-758-1006
  • Fax: 908-360-0511
Mailing address:
  • Phone: 908-758-1006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number40QA01278900
License Number StateNJ

VIII. Authorized Official

Name: MR. PHILIP SALVATORE PESCE
Title or Position: PHYSICAL THERAPIST
Credential: P.T.
Phone: 908-758-1006