Provider Demographics
NPI:1992870802
Name:PHYSICAL THERAPY ASSOCIATES OF WAYNE, INC.
Entity type:Organization
Organization Name:PHYSICAL THERAPY ASSOCIATES OF WAYNE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:HOLTERHOFF
Authorized Official - Suffix:
Authorized Official - Credentials:MA, PT
Authorized Official - Phone:973-835-2827
Mailing Address - Street 1:81 SURREY DR
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-5222
Mailing Address - Country:US
Mailing Address - Phone:973-835-2827
Mailing Address - Fax:973-835-1856
Practice Address - Street 1:2025 HAMBURG TPKE
Practice Address - Street 2:SUITE E
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-6260
Practice Address - Country:US
Practice Address - Phone:973-835-2827
Practice Address - Fax:973-835-1856
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00135400261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy