Provider Demographics
NPI:1700041795
Name:ANDOVER MOHAWK PHYSICAL THERAPY
Entity Type:Organization
Organization Name:ANDOVER MOHAWK PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:B
Authorized Official - Last Name:JONSSON
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:973-786-6045
Mailing Address - Street 1:8 LENAPE RD
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07821-4568
Mailing Address - Country:US
Mailing Address - Phone:973-786-6045
Mailing Address - Fax:973-786-6054
Practice Address - Street 1:8 LENAPE RD
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:NJ
Practice Address - Zip Code:07821-4568
Practice Address - Country:US
Practice Address - Phone:973-786-6045
Practice Address - Fax:973-786-6054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-19
Last Update Date:2009-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00588000261QP2000X
NJ40QAO1129700261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy