Provider Demographics
NPI:1639579279
Name:KETSELMAN, EUGENE (PT, DPT, FAAOMPT)
Entity Type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:
Last Name:KETSELMAN
Suffix:
Gender:M
Credentials:PT, DPT, FAAOMPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:726 US HIGHWAY 202
Mailing Address - Street 2:SUITE 320 UNIT 200
Mailing Address - City:BRIDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:08807-2737
Mailing Address - Country:US
Mailing Address - Phone:908-304-3620
Mailing Address - Fax:
Practice Address - Street 1:1200 US HIGHWAY 22 EAST
Practice Address - Street 2:SUITE 2000 UNIT W7
Practice Address - City:BRIDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:08807-2943
Practice Address - Country:US
Practice Address - Phone:908-304-3620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-02
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01566100225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist