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General NPI Number Information
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NPI Number | 1760079099
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Entity Type | Organization
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Legal Business Name | PHYSICAL THERAPY GYM, LLC
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Dates
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Enumeration Date | 12/21/2020
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Last Update Date | 12/21/2020
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Provider Practice Location Address
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Address Line | 365 BROAD ST
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City | BLOOMFIELD
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State | NJ
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Zip | 07003-2737
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Country | US
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Telephone | 609-795-2534
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Fax |
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Provider Business Mailing Address
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Address Line | 157 TAPPAN ST
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City | KEARNY
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State | NJ
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Zip | 07032-3316
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Country | US
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Telephone | 732-979-7456
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Fax |
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Authorized Official
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Title or Position | CO-OWNER/PHYSICAL THERAPIST
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Name | JESSE JOEL DELUNA
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Credential | DPT
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Telephone | 469-432-1975
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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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