MEDICARE: IRONBOUND PHYSICAL THERAPY & WELLNESS

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1114326816	OTHER	NJ	PHYSICAL THERAPY

General Provider Information

NPI Number	:	1780343152
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IRONBOUND PHYSICAL THERAPY & WELLNESS

Provider Business Mailing Address
First Line	:	PO BOX 1102
Second Line	:
City	:	MOUNTAINSIDE
State	:	NJ
Zip	:	07092-0102
Country	:	US
Telephone Number	:	973-873-5450
Fax Number	:

Provider Business Practice Location Address
First Line	:	280 ELM ST
Second Line	:
City	:	NEWARK
State	:	NJ
Zip	:	07105-2604
Country	:	US
Telephone Number	:	973-873-5450
Fax Number	:

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	GRACE BRITO
Credential	:
Telephone Number	:	973-873-5450

Provider Enumeration Date	:	12/14/2021
Last Update Date	:	01/13/2026

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Directions to “IRONBOUND PHYSICAL THERAPY & WELLNESS ” Practice Location

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