Healthcare Provider Details

I. General information

NPI: 1477290765
Provider Name (Legal Business Name): FUNCTIONAL PATHWAY THERAPY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2022
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 CORNWALL RD STE 120
MONMOUTH JUNCTION NJ
08852-2411
US

IV. Provider business mailing address

1100 CORNWALL RD STE 120
MONMOUTH JUNCTION NJ
08852-2411
US

V. Phone/Fax

Practice location:
  • Phone: 908-358-8615
  • Fax: 609-269-1451
Mailing address:
  • Phone: 908-358-8615
  • Fax: 609-269-1451

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JOAN OLEFORO
Title or Position: AUTHORIZED OFFICIAL
Credential: PT
Phone: 908-358-8615