Provider Demographics
NPI:1952955833
Name:PHZIO PHYSICAL THERAPY OF NEW JERSEY PC
Entity Type:Organization
Organization Name:PHZIO PHYSICAL THERAPY OF NEW JERSEY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DARWIN
Authorized Official - Middle Name:
Authorized Official - Last Name:FOGT
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:310-722-6574
Mailing Address - Street 1:11825 MAJOR ST
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230-6356
Mailing Address - Country:US
Mailing Address - Phone:310-722-6574
Mailing Address - Fax:
Practice Address - Street 1:11825 MAJOR ST
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90230-6356
Practice Address - Country:US
Practice Address - Phone:310-722-6574
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-29
Last Update Date:2019-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty