Provider Demographics
NPI:1427638006
Name:ST MATTHEW PHYSICAL THERAPY AND WELLNESS CENTER LLC
Entity type:Organization
Organization Name:ST MATTHEW PHYSICAL THERAPY AND WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:ANDRADA
Authorized Official - Last Name:MILLAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-688-9702
Mailing Address - Street 1:277 KENNEDY BLVD
Mailing Address - Street 2:
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002-1212
Mailing Address - Country:US
Mailing Address - Phone:201-688-9702
Mailing Address - Fax:
Practice Address - Street 1:438B W SIDE AVE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07304-1426
Practice Address - Country:US
Practice Address - Phone:201-688-9702
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-08
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy