Provider Demographics
NPI:1568541332
Name:REISER, CHAD (PT, MPT)
Entity Type:Individual
Prefix:MR
First Name:CHAD
Middle Name:
Last Name:REISER
Suffix:
Gender:M
Credentials:PT, MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:457 ELIZABETH ST
Mailing Address - Street 2:
Mailing Address - City:NEW MILFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07646-1014
Mailing Address - Country:US
Mailing Address - Phone:201-501-0292
Mailing Address - Fax:
Practice Address - Street 1:457 ELIZABETH ST
Practice Address - Street 2:
Practice Address - City:NEW MILFORD
Practice Address - State:NJ
Practice Address - Zip Code:07646-1014
Practice Address - Country:US
Practice Address - Phone:201-501-0292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00994200225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist