Healthcare Provider Details

I. General information

NPI: 1720962137
Provider Name (Legal Business Name): OMPT PELVIC HEALTH & WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2025
Last Update Date: 07/31/2025
Certification Date: 07/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 ROUTE 23 STE 205
POMPTON PLAINS NJ
07444-1025
US

IV. Provider business mailing address

4 MOUNTAIN AVE
WANAQUE NJ
07465-1315
US

V. Phone/Fax

Practice location:
  • Phone: 973-706-1130
  • Fax: 973-513-9056
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: OLGA KOZA
Title or Position: OWNER
Credential:
Phone: 973-706-1130