Provider Demographics
NPI:1215550744
Name:RIVERWALK PHYSICAL THERAPY AT RARITAN LLC
Entity Type:Organization
Organization Name:RIVERWALK PHYSICAL THERAPY AT RARITAN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:
Authorized Official - Last Name:PESCE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:908-758-1006
Mailing Address - Street 1:1130 ROUTE 202 STE E7
Mailing Address - Street 2:
Mailing Address - City:RARITAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08869-1444
Mailing Address - Country:US
Mailing Address - Phone:908-758-1006
Mailing Address - Fax:
Practice Address - Street 1:1130 ROUTE 202 STE E8
Practice Address - Street 2:
Practice Address - City:RARITAN
Practice Address - State:NJ
Practice Address - Zip Code:08869-1444
Practice Address - Country:US
Practice Address - Phone:908-758-1006
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-19
Last Update Date:2020-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy