Provider Demographics
NPI:1639646722
Name:PHYSICAL THERAPY AND WELLNESS AT SOMERSET
Entity Type:Organization
Organization Name:PHYSICAL THERAPY AND WELLNESS AT SOMERSET
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMMED
Authorized Official - Middle Name:H
Authorized Official - Last Name:RAZA
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:732-991-2542
Mailing Address - Street 1:13 CLYDE RD STE 101
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-5037
Mailing Address - Country:US
Mailing Address - Phone:173-264-9391
Mailing Address - Fax:
Practice Address - Street 1:13 CLYDE RD STE 101
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-5037
Practice Address - Country:US
Practice Address - Phone:173-264-9391
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-27
Last Update Date:2018-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy