Provider Demographics
NPI:1922665082
Name:BRANCH PHYSICAL THERAPY & WELLNESS PC
Entity Type:Organization
Organization Name:BRANCH PHYSICAL THERAPY & WELLNESS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIOS
Authorized Official - Middle Name:
Authorized Official - Last Name:CHRISTODOULOU
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:201-565-6342
Mailing Address - Street 1:770 JACKSON ST APT 839
Mailing Address - Street 2:
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-6973
Mailing Address - Country:US
Mailing Address - Phone:201-565-6342
Mailing Address - Fax:
Practice Address - Street 1:32 WASHINGTON ST STE 2A
Practice Address - Street 2:
Practice Address - City:TENAFLY
Practice Address - State:NJ
Practice Address - Zip Code:07670-3220
Practice Address - Country:US
Practice Address - Phone:201-565-6342
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-23
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy