Provider Demographics
NPI:1659404457
Name:OPT PHYSICAL THERAPY AND WELLNESS LLC
Entity Type:Organization
Organization Name:OPT PHYSICAL THERAPY AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:RAJESHWARI
Authorized Official - Middle Name:
Authorized Official - Last Name:DORAISWAMY
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:973-697-3460
Mailing Address - Street 1:PO BOX 241
Mailing Address - Street 2:
Mailing Address - City:TOWACO
Mailing Address - State:NJ
Mailing Address - Zip Code:07082-0241
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5758 BERKSHIRE VALLEY ROAD
Practice Address - Street 2:
Practice Address - City:OAK RIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07438-2685
Practice Address - Country:US
Practice Address - Phone:973-697-3460
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2012-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJQAO2733225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ050349Medicare ID - Type UnspecifiedPROVIDER NUMBER
NJ050227P0XMedicare ID - Type UnspecifiedGROUP NUMBER