Provider Demographics
NPI:1477290765
Name:FUNCTIONAL PATHWAY THERAPY SERVICES
Entity Type:Organization
Organization Name:FUNCTIONAL PATHWAY THERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:
Authorized Official - Last Name:OLEFORO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:908-358-8615
Mailing Address - Street 1:101A MAJOR RD
Mailing Address - Street 2:
Mailing Address - City:MONMOUTH JUNCTION
Mailing Address - State:NJ
Mailing Address - Zip Code:08852-2307
Mailing Address - Country:US
Mailing Address - Phone:908-358-8615
Mailing Address - Fax:
Practice Address - Street 1:101A MAJOR RD
Practice Address - Street 2:
Practice Address - City:MONMOUTH JUNCTION
Practice Address - State:NJ
Practice Address - Zip Code:08852-2307
Practice Address - Country:US
Practice Address - Phone:908-358-8615
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-18
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy