Healthcare Provider Details

I. General information

NPI: 1164928263
Provider Name (Legal Business Name): MICHAEL ESCARDA DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MICHAEL LUIS B ESCARDA DPT

II. Dates (important events)

Enumeration Date: 04/05/2018
Last Update Date: 03/04/2025
Certification Date: 03/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1043 W MAIN ST
FREEHOLD NJ
07728-2538
US

IV. Provider business mailing address

1043 W MAIN ST
FREEHOLD NJ
07728-2538
US

V. Phone/Fax

Practice location:
  • Phone: 732-800-9000
  • Fax: 732-840-2088
Mailing address:
  • Phone: 732-800-9000
  • Fax: 732-840-2088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberCP042714T
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305211818
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: