Provider Demographics
NPI:1710500152
Name:ETHOS PT LLC
Entity Type:Organization
Organization Name:ETHOS PT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:B
Authorized Official - Last Name:PUZIO
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, OCS
Authorized Official - Phone:201-290-4826
Mailing Address - Street 1:873 MAIN ST STE 2S
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-4930
Mailing Address - Country:US
Mailing Address - Phone:201-290-4826
Mailing Address - Fax:201-643-6195
Practice Address - Street 1:873 MAIN ST STE 2S
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-4930
Practice Address - Country:US
Practice Address - Phone:201-290-4826
Practice Address - Fax:201-643-6195
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-20
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty