Healthcare Provider Details

I. General information

NPI: 1649447988
Provider Name (Legal Business Name): BENEFIT PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2008
Last Update Date: 11/18/2022
Certification Date: 11/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

479 UNION AVE
BRIDGEWATER NJ
08807-3143
US

IV. Provider business mailing address

479 UNION AVE
BRIDGEWATER NJ
08807-3143
US

V. Phone/Fax

Practice location:
  • Phone: 973-214-3500
  • Fax:
Mailing address:
  • Phone: 973-214-3500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA01088500
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number40QA01088500
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number40QA01088500
License Number StateNJ

VIII. Authorized Official

Name: BRIAN IRELAND
Title or Position: OWNER
Credential: DPT, CERT MDT, CSCS
Phone: 908-203-5200