MEDICARE: MR. RUSSELL ALTMAN PT, DPT

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	40QA01414200	NJ

General Provider Information

NPI Number	:	1538496302
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RUSSELL ALTMAN PT, DPT

Provider Business Mailing Address
First Line	:	10 SUMMIT AVE
Second Line	:	STE 6
City	:	BERKELEY HEIGHTS
State	:	NJ
Zip	:	07922-1177
Country	:	US
Telephone Number	:	908-603-9605
Fax Number	:	908-934-9389

Provider Business Practice Location Address
First Line	:	10 SUMMIT AVE
Second Line	:	STE 1
City	:	BERKELEY HEIGHTS
State	:	NJ
Zip	:	07922-1177
Country	:	US
Telephone Number	:	908-603-9605
Fax Number	:	908-934-9389

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/15/2009
Last Update Date	:	04/16/2018

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