Provider Demographics
NPI:1598889479
Name:OLD BRIDGE CENTER OF PHYSICAL THERAPY INC
Entity Type:Organization
Organization Name:OLD BRIDGE CENTER OF PHYSICAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BHAVESH
Authorized Official - Middle Name:D
Authorized Official - Last Name:MISTRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-525-1133
Mailing Address - Street 1:200 PERRINE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:OLD BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08857-2842
Mailing Address - Country:US
Mailing Address - Phone:732-525-1133
Mailing Address - Fax:
Practice Address - Street 1:200 PERRINE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:OLD BRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:08857-2842
Practice Address - Country:US
Practice Address - Phone:732-525-1133
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-18
Last Update Date:2013-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00999300225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty