Provider Demographics
NPI:1295864510
Name:HILLSIDE PHYSICAL THERAPY
Entity Type:Organization
Organization Name:HILLSIDE PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:A
Authorized Official - Last Name:BREWSTER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:201-240-0918
Mailing Address - Street 1:1542 MORRIS PL
Mailing Address - Street 2:
Mailing Address - City:HILLSIDE
Mailing Address - State:NJ
Mailing Address - Zip Code:07205-1627
Mailing Address - Country:US
Mailing Address - Phone:201-240-0918
Mailing Address - Fax:973-926-2386
Practice Address - Street 1:1542 MORRIS PL
Practice Address - Street 2:
Practice Address - City:HILLSIDE
Practice Address - State:NJ
Practice Address - Zip Code:07205-1627
Practice Address - Country:US
Practice Address - Phone:201-240-0918
Practice Address - Fax:973-926-2386
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00205200225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty