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Organization
PROVERE PHYSICAL THERAPY - SPARTA
Active
Organization
PROVERE PHYSICAL THERAPY - SPARTA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CEDRIC HADDAD D.P.T (OWNER)
(732) 221-7617
Entity
Organization
Contact information
Practice address
14 PARK LAKE RD, SPARTA, NJ 07871-3241
(201) 485-8971
Mailing address
637 WYCKOFF AVE, PMB 362, WYCKOFF, NJ 07481-1438
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
40QA00611400
NJ
Other
Enumeration date
12/11/2015
Last updated
12/11/2015
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