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General NPI Number Information
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NPI Number | 1780059527
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Entity Type | Organization
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Legal Business Name | SHALOM THERAPEUTIC SERVICES LLC
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Dates
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Enumeration Date | 12/04/2015
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Last Update Date | 03/25/2025
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Provider Practice Location Address
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Address Line | 2245 US HIGHWAY 130 STE 105
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City | DAYTON
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State | NJ
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Zip | 08810-2420
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Country | US
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Telephone | 732-609-7155
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Fax |
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Provider Business Mailing Address
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Address Line | 2245 US HIGHWAY 130 STE 105
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City | DAYTON
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State | NJ
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Zip | 08810-2420
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Country | US
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Telephone | 732-609-7155
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | PRATHIBHA GOTTUMUKKALA
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Credential |
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Telephone | 732-609-7155
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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 | 40QA01534600
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License Number State | NJ
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