=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558134221
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CATALYST PHYSICAL THERAPY & WELLNESS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/03/2023
-----------------------------------------------------
Last Update Date | 11/03/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 200 SHEFFIELD ST STE 313
-----------------------------------------------------
City | MOUNTAINSIDE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07092-2321
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-947-2631
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 426 MAIN ST # 184
-----------------------------------------------------
City | SPOTSWOOD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08884-1702
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | NICOLE SALGE
-----------------------------------------------------
Credential | PT, DPT
-----------------------------------------------------
Telephone | 732-947-2631
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------