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General NPI Number Information
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NPI Number | 1194091249
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Entity Type | Organization
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Legal Business Name | CREST MANASQUAN PHYSICAL THERAPY PA
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Dates
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Enumeration Date | 03/22/2012
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Last Update Date | 03/22/2012
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Provider Practice Location Address
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Address Line | 2420 ROUTE 34
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City | MANASQUAN
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State | NJ
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Zip | 08736-1808
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Country | US
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Telephone | 732-212-0060
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Fax | 732-212-0061
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Provider Business Mailing Address
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Address Line | 66 W GILBERT ST 2ND FLOOR
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City | TINTON FALLS
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State | NJ
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Zip | 07701-4947
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Country | US
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Telephone | 732-212-0060
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Fax | 732-212-0061
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOSEPH J CALABRO
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Credential | DO
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Telephone | 732-212-0060
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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 |
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License Number State |
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