Provider Demographics
NPI:1952567299
Name:MAYES, CALVIN JR (PT)
Entity Type:Individual
Prefix:
First Name:CALVIN
Middle Name:
Last Name:MAYES
Suffix:JR
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-06
Last Update Date:2019-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01282400225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist