# INNOVATIVE PHYSICAL THERAPY AND FITNESS CENTER INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1184205072
- **Authorized official:** DENISE TAVARES (BILLING MANAGER)
- **Authorized official phone:** (732) 317-4105

## Contact information

- **Practice address:** 259 TALMADGE RD, EDISON, NJ 08817-2833
- **Practice address phone:** (732) 853-8177
- **Mailing address:** 259 TALMADGE RD, EDISON, NJ 08817-2833

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | NULL | Yes |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | — | Yes |

## Other

- **Enumeration date:** 04/21/2021
- **Last updated:** 03/15/2022