Provider Demographics
NPI:1235594979
Name:NEMATULLAH VASOWALA
Entity Type:Organization
Organization Name:NEMATULLAH VASOWALA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:NEMATULLAH
Authorized Official - Middle Name:Q
Authorized Official - Last Name:VASOWALA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:401-369-6952
Mailing Address - Street 1:1 S WOODLEIGH DR
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08003-3145
Mailing Address - Country:US
Mailing Address - Phone:856-427-7917
Mailing Address - Fax:
Practice Address - Street 1:1 S WOODLEIGH DR
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08003-3145
Practice Address - Country:US
Practice Address - Phone:856-427-7917
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-23
Last Update Date:2016-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01668100261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy