Healthcare Provider Details

I. General information

NPI: 1760398721
Provider Name (Legal Business Name): NICOLE GALVAO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 WELLBOOK PLACE
ISELIN NJ
08830
US

IV. Provider business mailing address

49 EISENHOWER DR
OLD BRIDGE NJ
08857-3920
US

V. Phone/Fax

Practice location:
  • Phone: 848-308-5110
  • Fax: 848-308-5111
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT40QA01107500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: