Healthcare Provider Details

I. General information

NPI: 1346078516
Provider Name (Legal Business Name): PHYSIS PHYSICAL THERAPY OF NEW JERSEY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2024
Last Update Date: 07/22/2024
Certification Date: 07/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

665 MARTINSVILLE RD STE 219
BASKING RIDGE NJ
07920-4700
US

IV. Provider business mailing address

5 HOUSTON ST
METUCHEN NJ
08840-1718
US

V. Phone/Fax

Practice location:
  • Phone: 908-745-1025
  • Fax:
Mailing address:
  • Phone: 908-745-1029
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: PRIYANKA DAVE
Title or Position: MANAGER
Credential: PT, DPT, OCS
Phone: 908-745-1029