Healthcare Provider Details

I. General information

NPI: 1619781309
Provider Name (Legal Business Name): 8TH STATE REHAB & WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2025
Last Update Date: 02/04/2025
Certification Date: 02/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 MEETING STREET RD UNIT 325
CHARLESTON SC
29405-9458
US

IV. Provider business mailing address

92 MYRTLE AVE
CEDAR GROVE NJ
07009-1420
US

V. Phone/Fax

Practice location:
  • Phone: 973-493-7529
  • Fax:
Mailing address:
  • Phone: 973-493-7529
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: TRAVIS J FAHEY
Title or Position: DOCTOR OF PHYSICAL THERAPY
Credential: DPT
Phone: 973-493-7529