MEDICARE: RIPTIDE PHYSICAL THERAPY, INC

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
1	225100000X	Physical Therapist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2626885000	OTHER	NJ	AMERIHEALTH PROVIDER #

General Provider Information

NPI Number	:	1376576363
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RIPTIDE PHYSICAL THERAPY, INC

Provider Business Mailing Address
First Line	:	249 S MAIN ST
Second Line	:	SUITE 1
City	:	BARNEGAT
State	:	NJ
Zip	:	08005-2301
Country	:	US
Telephone Number	:	609-607-0555
Fax Number	:	609-607-0178

Provider Business Practice Location Address
First Line	:	249 S MAIN ST
Second Line	:	SUITE 1
City	:	BARNEGAT
State	:	NJ
Zip	:	08005-2301
Country	:	US
Telephone Number	:	609-607-0555
Fax Number	:	609-607-0178

Authorized Official
Title or Position	:	OWNER
Name	:	GERARD P MCHUGH
Credential	:	PT
Telephone Number	:	609-607-0555

Provider Enumeration Date	:	07/10/2006
Last Update Date	:	06/21/2018

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Directions to “RIPTIDE PHYSICAL THERAPY, INC ” Practice Location

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