Healthcare Provider Details

I. General information

NPI: 1114081478
Provider Name (Legal Business Name): PHYSICAL THERAPY CENTER OF PERTH AMBOY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 MARKET ST STE.#101
PERTH AMBOY NJ
08861-4331
US

IV. Provider business mailing address

220 MARKET ST STE.#101
PERTH AMBOY NJ
08861-4331
US

V. Phone/Fax

Practice location:
  • Phone: 732-697-0001
  • Fax: 732-697-0044
Mailing address:
  • Phone: 732-697-0001
  • Fax: 732-697-0044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320700000X
TaxonomyPhysical Disabilities Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. KERI FESSLER
Title or Position: ADMIMISTRATOR
Credential:
Phone: 732-697-0001