MEDICARE: HOLSMAN PT REHABILITATION PC

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	225X00000X	Occupational Therapist	46TR00514000	NJ
2	235Z00000X	Speech-Language Pathologist	41YS00629500	NJ
3	225100000X	Physical Therapist	40QA00978900	NJ

General Provider Information

NPI Number	:	1760932172
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOLSMAN PT REHABILITATION 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	:	973-759-1494
Fax Number	:	973-759-0557

Provider Business Practice Location Address
First Line	:	361 MONTGOMERY ST
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07302-3345
Country	:	US
Telephone Number	:	201-932-2656
Fax Number	:	201-603-2454

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. RICHARD HOLSMAN
Credential	:	DPT, GCS
Telephone Number	:	973-393-5545

Provider Enumeration Date	:	10/10/2016
Last Update Date	:	10/10/2016

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