| NPI | 1063825206 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CANDY MAVURO Credentialing Specialist 732-440-1469 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 000000) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: NY 000000) |
| Enumeration Date | 2014-06-05 |
| Last Update Date | 2014-06-05 |