Healthcare Provider Details

I. General information

NPI: 1437126091
Provider Name (Legal Business Name): ADVANCED PHYSICAL THERAPY AND WELLNESS CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2006
Last Update Date: 02/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61 BEAVERBROOK RD SUITE 103
LINCOLN PARK NJ
07035-1748
US

IV. Provider business mailing address

61 BEAVERBROOK RD SUITE 103
LINCOLN PARK NJ
07035-1748
US

V. Phone/Fax

Practice location:
  • Phone: 973-305-0700
  • Fax: 973-305-0704
Mailing address:
  • Phone: 973-305-0700
  • Fax: 973-305-0704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. STEVEN B DICKERT
Title or Position: SOLE MEMBER
Credential: D.C.
Phone: 973-305-0700