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General NPI Number Information
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NPI Number | 1639294317
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Entity Type | Individual
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Provider Name | THOMAS JOSEPH XENAKIS PHYSICAL THERAPIST
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Gender | Male
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Dates
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Enumeration Date | 03/20/2007
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Last Update Date | 01/19/2010
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Provider Practice Location Address
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Address Line | 167 AVENUE AT THE CMN
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City | SHREWSBURY
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State | NJ
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Zip | 07702-4805
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Country | US
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Telephone | 732-673-9300
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Fax | 732-612-1298
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Provider Business Mailing Address
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Address Line | 526 SOUTH RIVERSIDE DR
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City | NEPTUNE
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State | NJ
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Zip | 07753
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Country | US
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Telephone | 732-673-9300
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 40QA00941400
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License Number State | NJ
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