Healthcare Provider Details

I. General information

NPI: 1588733224
Provider Name (Legal Business Name): ELSA M CANDELARIA PHYSICAL THERAPIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 W MAIN ST
FREEHOLD NJ
07728-2537
US

IV. Provider business mailing address

14 SPRUCE HOLLOW DR
HOWELL NJ
07731-3424
US

V. Phone/Fax

Practice location:
  • Phone: 732-294-2700
  • Fax:
Mailing address:
  • Phone: 732-462-5369
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberQA04660
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: