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General NPI Number Information
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NPI Number | 1205078946
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Entity Type | Organization
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Legal Business Name | TOTAL PHYSICAL THERAPY, LLC.
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Dates
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Enumeration Date | 03/26/2009
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Last Update Date | 03/26/2009
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Provider Practice Location Address
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Address Line | 25 E. SPRING VALLEY AVE SUITE 190
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City | MAYWOOD
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State | NJ
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Zip | 07607
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Country | US
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Telephone | 201-820-4604
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Fax | 201-820-4605
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Provider Business Mailing Address
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Address Line | 25 E. SPRING VALLEY AVE SUITE 190
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City | MAYWOOD
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State | NJ
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Zip | 07607
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Country | US
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Telephone | 201-820-4604
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Fax | 201-820-4605
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | MR. CHRISTIAN SYLVESTER GARTNER
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Credential | MSPT
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Telephone | 201-282-1142
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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 | 40QA00928200
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License Number State | NJ
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