Provider Demographics
NPI:1235474156
Name:TAWIL PHYSICAL THERAPY AND SPORTS PERFORMANCE, PA
Entity Type:Organization
Organization Name:TAWIL PHYSICAL THERAPY AND SPORTS PERFORMANCE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:TAWIL
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:201-394-9004
Mailing Address - Street 1:8701 KENNEDY BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTH BERGEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07047-4387
Mailing Address - Country:US
Mailing Address - Phone:201-552-9072
Mailing Address - Fax:201-552-9073
Practice Address - Street 1:8701 KENNEDY BLVD
Practice Address - Street 2:
Practice Address - City:NORTH BERGEN
Practice Address - State:NJ
Practice Address - Zip Code:07047-4387
Practice Address - Country:US
Practice Address - Phone:201-552-9072
Practice Address - Fax:201-552-9073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-04
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00985500225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty