Provider Demographics
NPI:1578552345
Name:COUWENBERG, RIK (PT)
Entity Type:Individual
Prefix:MR
First Name:RIK
Middle Name:
Last Name:COUWENBERG
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 MOUNT PLEASANT AVE
Mailing Address - Street 2:SUITE F
Mailing Address - City:DOVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07801-1629
Mailing Address - Country:US
Mailing Address - Phone:973-366-4000
Mailing Address - Fax:973-366-4998
Practice Address - Street 1:600 MOUNT PLEASANT AVE
Practice Address - Street 2:SUITE F
Practice Address - City:DOVER
Practice Address - State:NJ
Practice Address - Zip Code:07801-1629
Practice Address - Country:US
Practice Address - Phone:973-366-4000
Practice Address - Fax:973-366-4998
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-14
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00510500225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ036152Medicare ID - Type Unspecified