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NPI Code Detail

MEDICARE: MR. ILVE EVA MUST PT

MEDICARE: MR. ILVE EVA MUST PT
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
1225100000XPhysical Therapist40QA00204500NJ

General Provider Information

NPI Number : 1285833665
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. ILVE EVA MUST PT
Provider Business Mailing Address
First Line : 2207 LONGEST DR
Second Line :
City : TOMS RIVER
State : NJ
Zip : 08755-1411
Country : US
Telephone Number : 732-240-7493
Fax Number :
Provider Business Practice Location Address
First Line : 1579 OLD FREEHOLD RD
Second Line :
City : TOMS RIVER
State : NJ
Zip : 08755-2173
Country : US
Telephone Number : 732-505-4477
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/16/2007
Last Update Date : 07/16/2007

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