Healthcare Provider Details

I. General information

NPI: 1619547759
Provider Name (Legal Business Name): THEODORE OKOSI PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: TED C OKOSI PT, DPT

II. Dates (important events)

Enumeration Date: 06/30/2021
Last Update Date: 06/30/2021
Certification Date: 06/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

685 RIVER AVE
LAKEWOOD NJ
08701-5288
US

IV. Provider business mailing address

49 GREENWICH DR
JACKSON NJ
08527-4878
US

V. Phone/Fax

Practice location:
  • Phone: 732-367-3667
  • Fax:
Mailing address:
  • Phone: 908-839-2960
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA01504000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: