Provider Demographics
NPI:1518615400
Name:ESSENTIAL FOUNDATIONS PELVIC PHYSICAL THERAPY
Entity Type:Organization
Organization Name:ESSENTIAL FOUNDATIONS PELVIC PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:BILAND
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:732-216-8171
Mailing Address - Street 1:369 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNTAINSIDE
Mailing Address - State:NJ
Mailing Address - Zip Code:07092-1953
Mailing Address - Country:US
Mailing Address - Phone:732-216-8171
Mailing Address - Fax:
Practice Address - Street 1:642 VALLEY RD
Practice Address - Street 2:
Practice Address - City:GILLETTE
Practice Address - State:NJ
Practice Address - Zip Code:07933-2012
Practice Address - Country:US
Practice Address - Phone:732-216-8171
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-10
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy