MEDICARE: PALISADE PHYSICAL THERAPY AND REHABILITATION

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	261QP2000X	Physical Therapy Clinic/Center	40QA00799800	NJ

General Provider Information

NPI Number	:	1629244488
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PALISADE PHYSICAL THERAPY AND REHABILITATION

Provider Business Mailing Address
First Line	:	131 PALISADE AVE
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07306-1101
Country	:	US
Telephone Number	:	201-761-9490
Fax Number	:	201-792-5343

Provider Business Practice Location Address
First Line	:	131 PALISADE AVE
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07306-1101
Country	:	US
Telephone Number	:	201-761-9490
Fax Number	:	201-792-5343

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	MARIA VILLANUEVA AMPARO
Credential	:
Telephone Number	:	201-761-9490

Provider Enumeration Date	:	05/01/2008
Last Update Date	:	05/01/2008

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Directions to “PALISADE PHYSICAL THERAPY AND REHABILITATION ” Practice Location

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