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General NPI Number Information
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NPI Number | 1508063579
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Entity Type | Organization
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Legal Business Name | BODY AND MIND PHYSICAL THERAPY PC
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Dates
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Enumeration Date | 07/02/2007
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Last Update Date | 01/20/2010
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Provider Practice Location Address
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Address Line | 1037 ROUTE 46 SUITE 202
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City | CLIFTON
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State | NJ
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Zip | 07013-2451
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Country | US
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Telephone | 973-253-8500
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Fax | 973-253-8503
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Provider Business Mailing Address
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Address Line | 1037 ROUTE 46 SUITE 202
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City | CLIFTON
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State | NJ
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Zip | 07013-2451
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Country | US
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Telephone | 973-253-8500
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Fax | 973-253-8503
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ANNA MARIA POBLETE
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Credential | DPT
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Telephone | 973-253-8500
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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 | 40QA01110200
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License Number State | NJ
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