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General NPI Number Information
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NPI Number | 1548740087
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Entity Type | Organization
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Legal Business Name | HEALTH AND WELLNESS PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 08/15/2018
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Last Update Date | 08/15/2018
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Provider Practice Location Address
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Address Line | 412 PLEASANT VALLEY WAY STE 206
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City | WEST ORANGE
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State | NJ
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Zip | 07052-2934
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Country | US
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Telephone | 973-400-8741
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Fax |
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Provider Business Mailing Address
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Address Line | 412 PLEASANT VALLEY WAY STE 206
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City | WEST ORANGE
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State | NJ
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Zip | 07052-2934
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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 | OFFICE MANAGER
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Name | GRACE HANCOCK
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Credential |
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Telephone | 973-851-5939
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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 | 40QA01004800
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License Number State | NJ
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