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General NPI Number Information
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NPI Number | 1922665082
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Entity Type | Organization
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Legal Business Name | BRANCH PHYSICAL THERAPY & WELLNESS PC
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Dates
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Enumeration Date | 05/23/2019
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Last Update Date | 03/02/2022
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Provider Practice Location Address
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Address Line | 32 WASHINGTON ST STE 2A
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City | TENAFLY
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State | NJ
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Zip | 07670-3220
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Country | US
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Telephone | 201-565-6342
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Fax |
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Provider Business Mailing Address
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Address Line | 770 JACKSON ST APT 839
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City | HOBOKEN
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State | NJ
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Zip | 07030-6973
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Country | US
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Telephone | 201-565-6342
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MARIOS CHRISTODOULOU
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Credential | DPT
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Telephone | 201-565-6342
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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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