Provider Demographics
NPI:1225260144
Name:BADE, STEPHEN ALEXANDER (DPT)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:ALEXANDER
Last Name:BADE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1540 WEST PARK AVE.
Mailing Address - Street 2:SUITE 4
Mailing Address - City:TINTON FALLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07712
Mailing Address - Country:US
Mailing Address - Phone:732-544-0011
Mailing Address - Fax:732-544-1115
Practice Address - Street 1:1540 WEST PARK AVE.
Practice Address - Street 2:SUITE 4
Practice Address - City:TINTON FALLS
Practice Address - State:NJ
Practice Address - Zip Code:07712
Practice Address - Country:US
Practice Address - Phone:732-544-0011
Practice Address - Fax:732-544-1115
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-11
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA013214002251S0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports