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General NPI Number Information
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NPI Number | 1871854703
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Entity Type | Organization
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Legal Business Name | SYSTEM 4 LIVING WELL
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Dates
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Enumeration Date | 06/07/2012
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Last Update Date | 07/05/2012
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Provider Practice Location Address
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Address Line | 16 BRISTOL RD
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City | PISCATAWAY
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State | NJ
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Zip | 08854-3610
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Country | US
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Telephone | 732-640-7107
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Fax | 866-421-9357
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Provider Business Mailing Address
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Address Line | 16 BRISTOL RD
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City | PISCATAWAY
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State | NJ
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Zip | 08854-3610
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Country | US
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Telephone | 732-640-7107
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Fax | 866-421-9357
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Authorized Official
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Title or Position | CEO
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Name | DEXTER HOLMES
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Credential |
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Telephone | 732-640-7107
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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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