Provider Demographics
NPI:1578879474
Name:HEART & SOUL REHABILITATION
Entity Type:Organization
Organization Name:HEART & SOUL REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:W
Authorized Official - Last Name:EGERMAYER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:973-748-8100
Mailing Address - Street 1:733 BLOOMFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003-2545
Mailing Address - Country:US
Mailing Address - Phone:973-748-8100
Mailing Address - Fax:973-748-1055
Practice Address - Street 1:733 BLOOMFIELD AVE
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07003-2545
Practice Address - Country:US
Practice Address - Phone:973-748-8100
Practice Address - Fax:973-748-1055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-30
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJQA006740225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty