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General NPI Number Information
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NPI Number | 1881716702
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Entity Type | Individual
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Provider Name | RIZARUTH MARCOS BRAVO PT
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Gender | Female
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Dates
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Enumeration Date | 04/03/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 100 MCCLELLEN ST
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City | NORWOOD
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State | NJ
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Zip | 07648-1555
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Country | US
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Telephone | 201-768-6222
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Fax |
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Provider Business Mailing Address
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Address Line | 941 BOULEVARD APT. B
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City | NEW MILFORD
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State | NJ
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Zip | 07646-6430
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Country | US
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Telephone | 201-483-3912
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Fax | 201-483-3912
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 40QA01183900
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License Number State | NJ
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