Provider Demographics
NPI:1841589389
Name:IRON PHYSICAL THERAPY
Entity type:Organization
Organization Name:IRON PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CALVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MAYES
Authorized Official - Suffix:JR
Authorized Official - Credentials:PT
Authorized Official - Phone:973-228-4766
Mailing Address - Street 1:474 BLOOMFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07006-5402
Mailing Address - Country:US
Mailing Address - Phone:973-228-4766
Mailing Address - Fax:973-228-3778
Practice Address - Street 1:474 BLOOMFIELD AVE
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:NJ
Practice Address - Zip Code:07006-5402
Practice Address - Country:US
Practice Address - Phone:973-228-4766
Practice Address - Fax:973-228-3778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-05
Last Update Date:2019-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01282400261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy