Provider Demographics
NPI:1518097195
Name:EDISON PHYSICAL THERAPY & REHAB LLC
Entity Type:Organization
Organization Name:EDISON PHYSICAL THERAPY & REHAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SMITA
Authorized Official - Middle Name:
Authorized Official - Last Name:KADAKIA
Authorized Official - Suffix:
Authorized Official - Credentials:LPT
Authorized Official - Phone:732-321-1855
Mailing Address - Street 1:1907 OAK TREE RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-2070
Mailing Address - Country:US
Mailing Address - Phone:732-321-1855
Mailing Address - Fax:732-321-1866
Practice Address - Street 1:1907 OAK TREE RD
Practice Address - Street 2:SUITE 203
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-2070
Practice Address - Country:US
Practice Address - Phone:732-321-1855
Practice Address - Fax:732-321-1866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJQA02365225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty