Healthcare Provider Details

I. General information

NPI: 1770675514
Provider Name (Legal Business Name): TRINA FOLTZ PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 07/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 MONMOUTH RD
OAKHURST NJ
07755-1515
US

IV. Provider business mailing address

255 MONMOUTH RD
OAKHURST NJ
07755-1515
US

V. Phone/Fax

Practice location:
  • Phone: 732-660-1560
  • Fax: 732-660-1562
Mailing address:
  • Phone: 732-660-1560
  • Fax: 732-660-1562

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number40QA00765100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: