Healthcare Provider Details

I. General information

NPI: 1477845329
Provider Name (Legal Business Name): DEVON'S PROMISE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2011
Last Update Date: 05/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 COLONIAL TER
HACKENSACK NJ
07601-1403
US

IV. Provider business mailing address

455 COLONIAL TER
HACKENSACK NJ
07601-1403
US

V. Phone/Fax

Practice location:
  • Phone: 201-996-9264
  • Fax:
Mailing address:
  • Phone: 201-996-9264
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA00524900
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: LESLI WARRICK
Title or Position: PRESIDENT
Credential:
Phone: 201-996-9264