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General NPI Number Information
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NPI Number | 1194914416
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Entity Type | Organization
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Legal Business Name | AVENEL PHYSICAL THERAPY
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Dates
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Enumeration Date | 10/23/2007
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Last Update Date | 10/23/2007
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Provider Practice Location Address
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Address Line | 415 AVENEL ST
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City | AVENEL
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State | NJ
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Zip | 07001-1147
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Country | US
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Telephone | 732-636-7888
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Fax | 732-636-7887
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Provider Business Mailing Address
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Address Line | 415 AVENEL ST
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City | AVENEL
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State | NJ
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Zip | 07001-1147
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Country | US
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Telephone | 732-636-7888
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Fax | 732-636-7887
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Authorized Official
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Title or Position | PHSYICAL THERAPIST/PRESIDENT
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Name | MR. MICHAEL F DILELLA
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Credential | M.S.P.T.
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Telephone | 732-636-7888
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 40QA01192300
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License Number State | NJ
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