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General NPI Number Information
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NPI Number | 1659774875
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Entity Type | Organization
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Legal Business Name | THE RECOVERY ROOM PHYSICAL THERAPY AND ATHLETIC CENTER
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Dates
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Enumeration Date | 10/01/2014
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Last Update Date | 10/01/2014
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Provider Practice Location Address
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Address Line | 681 LAWLINS RD
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City | WYCKOFF
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State | NJ
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Zip | 07481-1449
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Country | US
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Telephone | 201-885-4200
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Fax |
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Provider Business Mailing Address
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Address Line | 425 3RD ST
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City | ORADELL
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State | NJ
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Zip | 07649-1717
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Country | US
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Telephone | 201-264-8652
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Fax |
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Authorized Official
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Title or Position | CO-OWNER
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Name | DR. DANIEL VIDAIC
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Credential | PT, DPT, CSCS
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Telephone | 201-264-8652
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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 | 40QA00904900
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License Number State | NJ
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