Healthcare Provider Details

I. General information

NPI: 1477751881
Provider Name (Legal Business Name): ACTIVE HEALTH PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2007
Last Update Date: 04/19/2024
Certification Date: 04/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 RIVER RD
EDGEWATER NJ
07020-1096
US

IV. Provider business mailing address

190 RIVER RD
EDGEWATER NJ
07020-1096
US

V. Phone/Fax

Practice location:
  • Phone: 201-941-2160
  • Fax: 877-552-2289
Mailing address:
  • Phone: 201-941-2160
  • Fax: 877-552-2289

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA01107000
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ROWENA P. SAYSON
Title or Position: PHYSICAL THERAPIST
Credential:
Phone: 201-941-2160