Provider Demographics
NPI:1487198628
Name:EUSEBIO, ERNEST S (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:ERNEST
Middle Name:S
Last Name:EUSEBIO
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 WARREN STREET UNIT #705
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302
Mailing Address - Country:US
Mailing Address - Phone:201-855-9681
Mailing Address - Fax:
Practice Address - Street 1:150 BAY STREET, 2ND-FLOOR COMMERCIAL ENTRANCE
Practice Address - Street 2:LOCATED INSIDE OF 150 BAY CROSSFIT
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07302
Practice Address - Country:US
Practice Address - Phone:201-855-9681
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-07
Last Update Date:2019-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01705900225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist