Healthcare Provider Details

I. General information

NPI: 1497532931
Provider Name (Legal Business Name): KRISHNA PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2023
Last Update Date: 09/08/2023
Certification Date: 09/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

246 RYDERS LN
MILLTOWN NJ
08850-1353
US

IV. Provider business mailing address

246 RYDERS LN
MILLTOWN NJ
08850-1353
US

V. Phone/Fax

Practice location:
  • Phone: 732-246-3585
  • Fax: 732-400-8474
Mailing address:
  • Phone: 732-246-3585
  • Fax: 732-400-8474

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DIVIK BHASIN
Title or Position: MEMBER
Credential:
Phone: 856-534-8086