Provider Demographics
NPI:1629159504
Name:ARMSTRONG, GRETCHEN (MSPT)
Entity Type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:
Last Name:ARMSTRONG
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:811 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:LYNDHURST
Mailing Address - State:NJ
Mailing Address - Zip Code:07071-1311
Mailing Address - Country:US
Mailing Address - Phone:973-746-2424
Mailing Address - Fax:973-746-5030
Practice Address - Street 1:1 GREENWOOD AVE
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-3617
Practice Address - Country:US
Practice Address - Phone:973-746-2424
Practice Address - Fax:973-746-5030
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01002600225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ087328RGNOtherMEDICARE ID