Healthcare Provider Details

I. General information

NPI: 1902535453
Provider Name (Legal Business Name): PHYSICAL COMPETENCE SYSTEM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2022
Last Update Date: 06/10/2022
Certification Date: 06/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 HEATH LN
JACKSON NJ
08527-4696
US

IV. Provider business mailing address

25 HEATH LN
JACKSON NJ
08527-4696
US

V. Phone/Fax

Practice location:
  • Phone: 201-403-7895
  • Fax:
Mailing address:
  • Phone: 201-403-7895
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2251C2600X
TaxonomyCardiopulmonary Physical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN THIEVON
Title or Position: AUTHORIZED OFFICIAL
Credential: PT, DPT
Phone: 201-403-7895