Provider Demographics
NPI:1639243454
Name:DEFINE PHYSICAL THERAPY & PERSONAL CARE
Entity Type:Organization
Organization Name:DEFINE PHYSICAL THERAPY & PERSONAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:EROLINA
Authorized Official - Middle Name:
Authorized Official - Last Name:MATTHEWS
Authorized Official - Suffix:
Authorized Official - Credentials:LPT
Authorized Official - Phone:732-566-1674
Mailing Address - Street 1:2 IVES PLACE
Mailing Address - Street 2:
Mailing Address - City:MATAWAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07747
Mailing Address - Country:US
Mailing Address - Phone:732-566-1674
Mailing Address - Fax:732-566-5889
Practice Address - Street 1:2 IVES PLACE
Practice Address - Street 2:
Practice Address - City:MATAWAN
Practice Address - State:NJ
Practice Address - Zip Code:07747
Practice Address - Country:US
Practice Address - Phone:732-566-1674
Practice Address - Fax:732-566-5889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2015-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJQA04918225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty