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General NPI Number Information
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NPI Number | 1104763622
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Entity Type | Individual
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Provider Name | GREGORY SOUSA DPT
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Gender | Male
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Dates
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Enumeration Date | 05/01/2026
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Last Update Date | 05/01/2026
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Provider Practice Location Address
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Address Line | 100 COMMONS WAY STE 120
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City | HOLMDEL
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State | NJ
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Zip | 07733-2937
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Country | US
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Telephone | 732-450-2920
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Fax |
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Provider Business Mailing Address
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Address Line | 33 APACHE TRL
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City | FREEHOLD
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State | NJ
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Zip | 07728-7884
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Country | US
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Telephone | 316-200-1092
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 40QA02366000
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License Number State | NJ
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