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General NPI Number Information
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NPI Number | 1265071187
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Entity Type | Organization
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Legal Business Name | ASHLEY MAK PERFORMANCE AND REHABILITATION, PC
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Dates
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Enumeration Date | 12/23/2019
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Last Update Date | 12/23/2019
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Provider Practice Location Address
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Address Line | 1320 ADAMS ST STE B
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City | HOBOKEN
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State | NJ
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Zip | 07030-2370
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Country | US
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Telephone | 201-429-5620
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Fax |
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Provider Business Mailing Address
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Address Line | 24 MARSH RD
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City | TIBURON
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State | CA
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Zip | 94920-2541
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Country | US
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Telephone | 646-821-3390
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. ASHLEY MAK
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Credential | PT, DPT
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Telephone | 646-821-3390
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number |
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License Number State |
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