Healthcare Provider Details

I. General information

NPI: 1568840080
Provider Name (Legal Business Name): MAYWOOD PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2015
Last Update Date: 09/15/2022
Certification Date: 09/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 E PASSAIC ST
MAYWOOD NJ
07607-1342
US

IV. Provider business mailing address

119 E PASSAIC ST
MAYWOOD NJ
07607-1342
US

V. Phone/Fax

Practice location:
  • Phone: 201-880-7787
  • Fax:
Mailing address:
  • Phone: 201-880-7787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number40QA01639000
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number38MC00710100
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number38MC00722200
License Number StateNJ

VIII. Authorized Official

Name: DR. DANIEL HANNA
Title or Position: CHIROPRACTOR/OWNER
Credential: DC
Phone: 201-880-7787