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NPI Code Detail

MEDICARE: MATRIX PHYSICAL THERAPY,LLC

MEDICARE: MATRIX PHYSICAL THERAPY,LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QP2000XPhysical Therapy Clinic/Center40QA01179000NJ

General Provider Information

NPI Number : 1033105325
Entity Type Code : Organization
Provider Name (Legal Business Name) : MATRIX PHYSICAL THERAPY,LLC
Provider Business Mailing Address
First Line : 222 KINDERKAMACK RD
Second Line :
City : ORADELL
State : NJ
Zip : 07649-2259
Country : US
Telephone Number : 212-794-0820
Fax Number : 201-265-9817
Provider Business Practice Location Address
First Line : 222 KINDERKAMACK RD
Second Line :
City : ORADELL
State : NJ
Zip : 07649-2259
Country : US
Telephone Number : 212-794-0820
Fax Number : 201-265-9817
Authorized Official
Title or Position : OWNER
Name : DR. DEBRA A LIEBOWITZ
Credential : PT
Telephone Number : 212-794-0820
Provider Enumeration Date : 09/22/2005
Last Update Date : 08/22/2020

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