Provider Demographics
NPI:1831522739
Name:MONMOUTH MANUAL THERAPY, LLC
Entity type:Organization
Organization Name:MONMOUTH MANUAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:BUCHALA
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:201-232-0069
Mailing Address - Street 1:280 NORWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:WEST LONG BRANCH
Mailing Address - State:NJ
Mailing Address - Zip Code:07764-1879
Mailing Address - Country:US
Mailing Address - Phone:732-222-1704
Mailing Address - Fax:
Practice Address - Street 1:280 NORWOOD AVE
Practice Address - Street 2:
Practice Address - City:WEST LONG BRANCH
Practice Address - State:NJ
Practice Address - Zip Code:07764-1879
Practice Address - Country:US
Practice Address - Phone:732-222-1704
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-14
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01401200225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty