Healthcare Provider Details

I. General information

NPI: 1366332405
Provider Name (Legal Business Name): BESPOKE PHYSICAL THERAPY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2025
Last Update Date: 07/09/2025
Certification Date: 07/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 14TH ST
HOBOKEN NJ
07030-4441
US

IV. Provider business mailing address

210 14TH ST
HOBOKEN NJ
07030-4441
US

V. Phone/Fax

Practice location:
  • Phone: 646-596-7427
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TOMOKAZU KATO
Title or Position: PHYSICAL THERAPIST
Credential: PT
Phone: 646-596-7427