Provider Demographics
NPI:1326646753
Name:TEBANGIN, JOSHUA (DPT)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:
Last Name:TEBANGIN
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 1:7 WINDSOR DR
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07860-2324
Mailing Address - Country:US
Mailing Address - Phone:973-896-3607
Mailing Address - Fax:
Practice Address - Street 1:239 MILLBURN AVE
Practice Address - Street 2:
Practice Address - City:MILLBURN
Practice Address - State:NJ
Practice Address - Zip Code:07041-1718
Practice Address - Country:US
Practice Address - Phone:862-308-0222
Practice Address - Fax:862-345-9090
Is Sole Proprietor?:No
Enumeration Date:2020-10-16
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01964500225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist