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General NPI Number Information
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NPI Number | 1881236362
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Entity Type | Organization
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Legal Business Name | PHYSICAL THERAPY LAB
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Dates
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Enumeration Date | 10/16/2019
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Last Update Date | 11/19/2019
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Provider Practice Location Address
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Address Line | 210 SUMMIT AVE STE B1
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City | MONTVALE
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State | NJ
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Zip | 07645-1526
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Country | US
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Telephone | 201-683-3500
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Fax |
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Provider Business Mailing Address
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Address Line | 11 HILTON PL
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City | MONTVALE
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State | NJ
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Zip | 07645-1206
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Country | US
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Telephone | 914-772-5586
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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 | MRS. EVE KOPPELMAN
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Credential | MSPT
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Telephone | 914-772-5586
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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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