Provider Demographics
NPI:1487223970
Name:WASHINGTON, TOLAN (PT, CN, FUNCTIONAL M)
Entity Type:Individual
Prefix:MR
First Name:TOLAN
Middle Name:
Last Name:WASHINGTON
Suffix:
Gender:M
Credentials:PT, CN, FUNCTIONAL M
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:176 GREGORY AVE
Mailing Address - Street 2:
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-4620
Mailing Address - Country:US
Mailing Address - Phone:973-803-2063
Mailing Address - Fax:
Practice Address - Street 1:176 GREGORY AVE
Practice Address - Street 2:
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-4620
Practice Address - Country:US
Practice Address - Phone:973-803-2063
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-21
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1200458281373H00000X, 225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical RehabilitationGroup - Single Specialty
No373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist