=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417751280
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VIVA MOTION THERAPY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/02/2025
-----------------------------------------------------
Last Update Date | 04/02/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 272 HIGH ST STE 100
-----------------------------------------------------
City | PERTH AMBOY
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08861-5073
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-530-2475
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 227 HADLEIGH DR
-----------------------------------------------------
City | CHERRY HILL
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08003-1936
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-530-2475
-----------------------------------------------------
Fax | 856-673-0212
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHAIRMAN
-----------------------------------------------------
Name | ERUM KHAN
-----------------------------------------------------
Credential | DPT
-----------------------------------------------------
Telephone | 215-530-2475
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------