Provider Demographics
NPI:1750681201
Name:RIVERWALK PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:RIVERWALK PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:SALVATORE
Authorized Official - Last Name:PESCE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:908-758-1006
Mailing Address - Street 1:25 MOUNTAINVIEW BLVD STE 207
Mailing Address - Street 2:
Mailing Address - City:BASKING RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07920-3453
Mailing Address - Country:US
Mailing Address - Phone:908-758-1006
Mailing Address - Fax:
Practice Address - Street 1:25 MOUNTAINVIEW BLVD STE 207
Practice Address - Street 2:
Practice Address - City:BASKING RIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07920-3453
Practice Address - Country:US
Practice Address - Phone:908-758-1006
Practice Address - Fax:908-360-0511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-01
Last Update Date:2020-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171100000X, 225100000X, 235Z00000X
NJ40QA01278900261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty