=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922587013
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | METCON MECHANICS PT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/09/2018
-----------------------------------------------------
Last Update Date | 08/09/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 24 COKESBURY RD STE 5
-----------------------------------------------------
City | LEBANON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08833-2218
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-319-9931
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6 MIDVALE DR
-----------------------------------------------------
City | PITTSTOWN
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08867-4242
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-319-9931
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICAL THERAPIST/ OWNER
-----------------------------------------------------
Name | KATHRYN DOWD
-----------------------------------------------------
Credential | PT, DPT
-----------------------------------------------------
Telephone | 908-319-9931
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------