Healthcare Provider Details

I. General information

NPI: 1154400083
Provider Name (Legal Business Name): NATURAL MEDICINE & REHABILITATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 12 WEST END COURT
LONG BRANCH NM
07740
US

IV. Provider business mailing address

10-12 WEST END COURT
LONG BRANCH NJ
07740
US

V. Phone/Fax

Practice location:
  • Phone: 732-222-7799
  • Fax: 732-222-7996
Mailing address:
  • Phone: 732-222-7799
  • Fax: 732-222-7996

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA01197100
License Number StateNJ

VIII. Authorized Official

Name: JOHN J ROCHA
Title or Position: PHYSICAL THERAPIST
Credential: DPT
Phone: 732-222-7799