Provider Demographics
NPI:1508327289
Name:BODY MOKSHA PHYSICAL THERAPY
Entity Type:Organization
Organization Name:BODY MOKSHA PHYSICAL THERAPY
Other - Org Name:BODY MOKSHA PHYSICAL THERAPY
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER AND PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:TEJAL
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMAIYA
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:973-310-2678
Mailing Address - Street 1:466 SOUTHERN BLVD.
Mailing Address - Street 2:ADAMS BUILDING, 1ST FLOOR
Mailing Address - City:CHATHAM
Mailing Address - State:NJ
Mailing Address - Zip Code:07928
Mailing Address - Country:US
Mailing Address - Phone:973-310-2678
Mailing Address - Fax:973-327-5357
Practice Address - Street 1:466 SOUTHERN BLVD.
Practice Address - Street 2:ADAMS BUILDING, 1ST FLOOR
Practice Address - City:CHATHAM
Practice Address - State:NJ
Practice Address - Zip Code:07928
Practice Address - Country:US
Practice Address - Phone:973-310-2678
Practice Address - Fax:973-327-5357
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-26
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty