Healthcare Provider Details

I. General information

NPI: 1093489452
Provider Name (Legal Business Name): HEALING HANDS ON PHYSICAL THERAPY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2021
Last Update Date: 08/08/2021
Certification Date: 08/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 NEWARK AVE STE 3
BELLEVILLE NJ
07109-4154
US

IV. Provider business mailing address

77 NEWARK AVE STE 3
BELLEVILLE NJ
07109-4154
US

V. Phone/Fax

Practice location:
  • Phone: 201-277-4361
  • Fax: 848-238-2009
Mailing address:
  • Phone: 201-277-4361
  • Fax: 848-238-2009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. ALLAN ROQUE MENDEZ
Title or Position: DOCTOR OF PHYSICAL THERAPY
Credential: DPT, SCS
Phone: 973-870-2272