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General NPI Number Information
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NPI Number | 1487702791
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Entity Type | Organization
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Legal Business Name | FOUR CORNERS PHYSICAL THERAPY, LLC
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Dates
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Enumeration Date | 01/05/2007
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Last Update Date | 10/10/2012
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Provider Practice Location Address
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Address Line | 17 HANOVER RD BUILDING 300
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City | FLORHAM PARK
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State | NJ
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Zip | 07932-1411
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Country | US
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Telephone | 973-845-2592
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Fax | 973-845-2593
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Provider Business Mailing Address
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Address Line | 17 HANOVER RD BUILDING 300
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City | FLORHAM PARK
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State | NJ
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Zip | 07932-1411
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Country | US
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Telephone | 973-845-2592
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Fax | 973-845-2593
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | DEBRA GOLDMAN
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Credential | P.T.
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Telephone | 973-239-8889
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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 | 40QA00951200
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License Number State | NJ
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