Healthcare Provider Details

I. General information

NPI: 1578924338
Provider Name (Legal Business Name): WISE GUY PT, WELLNESS AND REHAB
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2016
Last Update Date: 03/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

136 FRANKLIN CORNER RD
LAWRENCEVILLE NJ
08648-2586
US

IV. Provider business mailing address

74 HILLMAN AVE
EWING NJ
08638-2874
US

V. Phone/Fax

Practice location:
  • Phone: 609-912-0440
  • Fax: 609-912-1908
Mailing address:
  • Phone: 609-618-2396
  • Fax: 609-912-1908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA01050600
License Number StateNJ

VIII. Authorized Official

Name: JOHN J CAMBRIA
Title or Position: OWNER/PHYSICAL THERAPIST
Credential: PT
Phone: 609-618-2396