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General NPI Number Information
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NPI Number | 1518615400
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Entity Type | Organization
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Legal Business Name | ESSENTIAL FOUNDATIONS PELVIC PHYSICAL THERAPY
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Dates
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Enumeration Date | 03/10/2022
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Last Update Date | 03/10/2022
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Provider Practice Location Address
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Address Line | 642 VALLEY RD
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City | GILLETTE
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State | NJ
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Zip | 07933-2012
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Country | US
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Telephone | 732-216-8171
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Fax |
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Provider Business Mailing Address
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Address Line | 369 CENTRAL AVE
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City | MOUNTAINSIDE
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State | NJ
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Zip | 07092-1953
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Country | US
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Telephone | 732-216-8171
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | REBECCA BILAND
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Credential | DPT
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Telephone | 732-216-8171
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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 |
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License Number State |
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