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General NPI Number Information
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NPI Number | 1780871764
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Entity Type | Organization
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Legal Business Name | KIMBERLY PHYSICAL THERAPY INC
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Dates
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Enumeration Date | 10/03/2007
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Last Update Date | 04/08/2008
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Provider Practice Location Address
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Address Line | 1270 HIGHWAY 35
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City | MIDDLETOWN
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State | NJ
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Zip | 07748-2014
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Country | US
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Telephone | 973-361-6054
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Fax | 973-361-0272
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Provider Business Mailing Address
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Address Line | PO BOX 29
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City | EDGEWATER
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State | NJ
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Zip | 07020-0029
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Country | US
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Telephone | 973-361-6054
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Fax | 973-361-0272
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. EDILBERTO O. ESTOMO JR.
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Credential |
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Telephone | 973-361-6054
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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 | 40QA00520400
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License Number State | NJ
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