Provider Demographics
NPI:1578924338
Name:WISE GUY PT, WELLNESS AND REHAB
Entity Type:Organization
Organization Name:WISE GUY PT, WELLNESS AND REHAB
Other - Org Name:WISE GUY PT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:CAMBRIA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:609-618-2396
Mailing Address - Street 1:74 HILLMAN AVE
Mailing Address - Street 2:
Mailing Address - City:EWING
Mailing Address - State:NJ
Mailing Address - Zip Code:08638-2874
Mailing Address - Country:US
Mailing Address - Phone:609-618-2396
Mailing Address - Fax:609-912-1908
Practice Address - Street 1:136 FRANKLIN CORNER RD
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08648-2586
Practice Address - Country:US
Practice Address - Phone:609-912-0440
Practice Address - Fax:609-912-1908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-08
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01050600225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty