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General NPI Number Information
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NPI Number | 1215339163
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Entity Type | Organization
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Legal Business Name | CJ PHYSICAL THERAPY AND WELLNESS, LLC
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Dates
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Enumeration Date | 09/23/2014
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Last Update Date | 09/23/2014
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Provider Practice Location Address
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Address Line | 34 FABYAN PT
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City | NEWINGTON
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State | NH
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Zip | 03801-2756
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Country | US
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Telephone | 617-545-7505
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Fax |
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Provider Business Mailing Address
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Address Line | 10 VAUGHAN MALL SUITE 216
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City | PORTSMOUTH
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State | NH
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Zip | 03801-4047
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST/OWNER
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Name | CARRIE JOSE
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Credential |
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Telephone | 617-545-7505
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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 | 3895
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License Number State | NH
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