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General NPI Number Information
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NPI Number | 1821677956
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Entity Type | Organization
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Legal Business Name | PHYSICAL THERAPY DOCTOR NJ, PC
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Dates
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Enumeration Date | 04/06/2021
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Last Update Date | 04/06/2021
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Provider Practice Location Address
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Address Line | 719 N BEERS ST STE 2B
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City | HOLMDEL
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State | NJ
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Zip | 07733-1523
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Country | US
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Telephone | 732-847-9922
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Fax |
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Provider Business Mailing Address
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Address Line | 719 N BEERS ST STE 2B
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City | HOLMDEL
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State | NJ
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Zip | 07733-1523
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Country | US
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Telephone | 732-847-9922
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | IRINA FOOKSON
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Credential |
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Telephone | 732-847-9922
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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 |
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License Number State |
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