Provider Demographics
NPI:1407128440
Name:PHYSICAL THERAPY INSTITUTE OF PATERSON
Entity Type:Organization
Organization Name:PHYSICAL THERAPY INSTITUTE OF PATERSON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:GEWANT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:201-286-4331
Mailing Address - Street 1:586 E 27TH ST
Mailing Address - Street 2:
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07504-1922
Mailing Address - Country:US
Mailing Address - Phone:973-553-1704
Mailing Address - Fax:973-742-6664
Practice Address - Street 1:586 E 27TH ST
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07504-1922
Practice Address - Country:US
Practice Address - Phone:973-553-1704
Practice Address - Fax:973-742-6664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-07
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation PractitionerGroup - Single Specialty