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General NPI Number Information
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NPI Number | 1316159577
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Entity Type | Individual
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Provider Name | BRENT DAVID REITZ MSPT
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Gender | Male
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 08/02/2007
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Provider Practice Location Address
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Address Line | 150 NEW PROVIDENCE ROAD
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City | MOUNTAINSIDE
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State | NJ
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Zip | 07092
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Country | US
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Telephone | 908-301-5486
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Fax |
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Provider Business Mailing Address
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Address Line | 40 CEDAR GROVE ROAD
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City | BRANCHBURG
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State | NJ
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Zip | 08876
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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 |
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Name |
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Credential |
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Telephone |
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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 | QA009419
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License Number State | NJ
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