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General NPI Number Information
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NPI Number | 1669782025
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Entity Type | Organization
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Legal Business Name | PRO FUNCTION PHYSICAL THERAPY P.C.
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Dates
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Enumeration Date | 10/19/2010
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Last Update Date | 10/19/2010
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Provider Practice Location Address
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Address Line | 545 ISLAND RD UNIT 2B-2
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City | RAMSEY
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State | NJ
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Zip | 07446-2813
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Country | US
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Telephone | 917-459-8033
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Fax |
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Provider Business Mailing Address
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Address Line | 49 SOMERS AVE
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City | BERGENFIELD
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State | NJ
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Zip | 07621-2607
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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 | PRESIDENT
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Name | EDITHA VICTORIA
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Credential |
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Telephone | 917-459-8033
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 40QA01306300
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License Number State | NJ
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