Healthcare Provider Details

I. General information

NPI: 1134018476
Provider Name (Legal Business Name): REMOTE PHYSICAL THERAPY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2025
Last Update Date: 07/01/2025
Certification Date: 07/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 42ND ST
BROOKLYN NY
11219-1213
US

IV. Provider business mailing address

304 GARRETT RD
MOUNTAINSIDE NJ
07092-1810
US

V. Phone/Fax

Practice location:
  • Phone: 201-870-1194
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. ARTHUR SHEVARDNADZE
Title or Position: COO
Credential:
Phone: 201-870-1194