MEDICARE: HOLSMAN ORTHOPEDIC AND SPORTS PHYSICAL THERAPY PC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number State
1	225X00000X	Occupational Therapist	NJ
2	235Z00000X	Speech-Language Pathologist	NJ
3	225100000X	Physical Therapist	NJ

General Provider Information

NPI Number	:	1033540521
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOLSMAN ORTHOPEDIC AND SPORTS PHYSICAL THERAPY PC

Provider Business Mailing Address
First Line	:	710 MILL ST
Second Line	:	UNIT H3
City	:	BELLEVILLE
State	:	NJ
Zip	:	07109-5318
Country	:	US
Telephone Number	:	862-591-1000
Fax Number	:	862-591-1005

Provider Business Practice Location Address
First Line	:	1700 RT 3 WEST
Second Line	:
City	:	CLIFTON
State	:	NJ
Zip	:	07013-3928
Country	:	US
Telephone Number	:	862-591-1000
Fax Number	:	862-591-1005

Authorized Official
Title or Position	:	PRESIDENT AND CEO
Name	:	DR. RICHARD S HOLSMAN
Credential	:	PT, DPT, MAT, GCS
Telephone Number	:	973-759-1494

Provider Enumeration Date	:	12/09/2013
Last Update Date	:	12/09/2013

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