Healthcare Provider Details

I. General information

NPI: 1801928759
Provider Name (Legal Business Name): PIVOTAL PHYSICAL THERAPY & WELLNESS CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 07/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

239 PROSPECT PLAINS RD SUITE B101
MONROE TOWNSHIP NJ
08831-3704
US

IV. Provider business mailing address

PO BOX 237
ROCKY HILL NJ
08553-0237
US

V. Phone/Fax

Practice location:
  • Phone: 609-395-9955
  • Fax: 609-395-1605
Mailing address:
  • Phone: 609-683-4747
  • Fax: 609-683-3837

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. JAMES J KENNY
Title or Position: PRINCIPAL
Credential: PT
Phone: 609-683-4747