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Organization
PROVERE PHYSICAL THERAPY - MONTCLAIR, LLC
Active
Organization
PROVERE PHYSICAL THERAPY - MONTCLAIR, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CEDRIC HADDAD (CEO)
(201) 485-8971
Entity
Organization
Contact information
Practice address
19 ELM ST, MONTCLAIR, NJ 07042-3451
(201) 485-8971
Mailing address
637 WYCKOFF AVE, UNIT 364, WYCKOFF, NJ 07481-1438
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
2251S0007X
Sports Physical Therapist
—
—
2251X0800X
Orthopedic Physical Therapist
—
—
Other
Enumeration date
03/16/2016
Last updated
03/16/2016
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