Healthcare Provider Details

I. General information

NPI: 1316014244
Provider Name (Legal Business Name): FAMILY FOCUS PHYSICAL THERAPY PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2510 BELMAR BLVD J1 J2
WALL NJ
07719
US

IV. Provider business mailing address

PO BOX 1703
WALL NJ
07719
US

V. Phone/Fax

Practice location:
  • Phone: 732-681-1122
  • Fax: 732-681-0999
Mailing address:
  • Phone: 732-681-1122
  • Fax: 732-681-0999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. PAMELA A MINNIS
Title or Position: PRESIDENT
Credential: PT
Phone: 732-681-1122