Healthcare Provider Details

I. General information

NPI: 1497451421
Provider Name (Legal Business Name): OLIVIA HORANT PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2023
Last Update Date: 02/01/2023
Certification Date: 02/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2510 BELMAR BLVD
WALL NJ
07719-3948
US

IV. Provider business mailing address

605 MAIN ST
HACKENSACK NJ
07601-5914
US

V. Phone/Fax

Practice location:
  • Phone: 732-681-1122
  • Fax: 732-681-0999
Mailing address:
  • Phone: 201-488-0488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA02150300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: