Provider Demographics
NPI:1619547759
Name:OKOSI, THEODORE (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:
Last Name:OKOSI
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:DR
Other - First Name:TED
Other - Middle Name:C
Other - Last Name:OKOSI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:49 GREENWICH DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08527-4878
Mailing Address - Country:US
Mailing Address - Phone:908-839-2960
Mailing Address - Fax:
Practice Address - Street 1:685 RIVER AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-5288
Practice Address - Country:US
Practice Address - Phone:732-367-3667
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-30
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01504000225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJNAMedicaid