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General NPI Number Information
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NPI Number | 1780733212
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Entity Type | Organization
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Legal Business Name | PHYSICAL THERAPY SPORTS REHAB
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Dates
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Enumeration Date | 01/10/2007
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 585 MAIN ST
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City | WOODBRIDGE
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State | NJ
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Zip | 07095-1104
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Country | US
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Telephone | 732-636-5151
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Fax | 732-602-0046
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Provider Business Mailing Address
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Address Line | 585 MAIN ST
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City | WOODBRIDGE
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State | NJ
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Zip | 07095-1104
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Country | US
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Telephone | 732-636-5151
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Fax | 732-602-0046
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Authorized Official
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Title or Position | DIRECTOR OF PHYSICAL THERAPY
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Name | MS. MARY JO BRONSON
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Credential | PT
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Telephone | 732-636-5151
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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 | NJ
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