Provider Demographics
NPI:1649756024
Name:RAPHA WELLNESS CENTER, PC
Entity Type:Organization
Organization Name:RAPHA WELLNESS CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RIMOUN
Authorized Official - Middle Name:
Authorized Official - Last Name:HANNA
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:201-778-2020
Mailing Address - Street 1:305 BAYONNE CROSSING WAY
Mailing Address - Street 2:
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002-5304
Mailing Address - Country:US
Mailing Address - Phone:201-778-2020
Mailing Address - Fax:
Practice Address - Street 1:305 BAYONNE CROSSING WAY
Practice Address - Street 2:
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-5304
Practice Address - Country:US
Practice Address - Phone:201-778-2020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-18
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty