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General NPI Number Information
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NPI Number | 1619781309
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Entity Type | Organization
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Legal Business Name | 8TH STATE REHAB & WELLNESS
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Dates
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Enumeration Date | 02/04/2025
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Last Update Date | 02/04/2025
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Provider Practice Location Address
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Address Line | 1310 MEETING STREET RD UNIT 325
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City | CHARLESTON
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State | SC
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Zip | 29405-9458
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Country | US
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Telephone | 973-493-7529
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Fax |
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Provider Business Mailing Address
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Address Line | 92 MYRTLE AVE
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City | CEDAR GROVE
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State | NJ
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Zip | 07009-1420
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Country | US
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Telephone | 973-493-7529
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Fax |
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Authorized Official
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Title or Position | DOCTOR OF PHYSICAL THERAPY
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Name | TRAVIS J FAHEY
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Credential | DPT
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Telephone | 973-493-7529
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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 |
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License Number State |
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