Provider Demographics
NPI:1376576363
Name:RIPTIDE PHYSICAL THERAPY, INC
Entity Type:Organization
Organization Name:RIPTIDE PHYSICAL THERAPY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GERARD
Authorized Official - Middle Name:P
Authorized Official - Last Name:MCHUGH
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:609-607-0555
Mailing Address - Street 1:249 S MAIN ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BARNEGAT
Mailing Address - State:NJ
Mailing Address - Zip Code:08005-2301
Mailing Address - Country:US
Mailing Address - Phone:609-607-0555
Mailing Address - Fax:609-607-0178
Practice Address - Street 1:249 S MAIN ST
Practice Address - Street 2:SUITE 1
Practice Address - City:BARNEGAT
Practice Address - State:NJ
Practice Address - Zip Code:08005-2301
Practice Address - Country:US
Practice Address - Phone:609-607-0555
Practice Address - Fax:609-607-0178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2626885000OtherAMERIHEALTH PROVIDER #
NJ2626885000OtherAMERIHEALTH PROVIDER #