Healthcare Provider Details

I. General information

NPI: 1831465061
Provider Name (Legal Business Name): ARIELLE N BRETTLER DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2012
Last Update Date: 04/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1199 PLEASANT VALLEY WAY
WEST ORANGE NJ
07052-1424
US

IV. Provider business mailing address

1199 PLEASANT VALLEY WAY
WEST ORANGE NJ
07052-1424
US

V. Phone/Fax

Practice location:
  • Phone: 973-731-3600
  • Fax: 973-243-6819
Mailing address:
  • Phone: 973-731-3600
  • Fax: 973-243-6819

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA01362700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: