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Organization
KODIAK PHYSICAL THERAPY LLC
Active
Organization
KODIAK PHYSICAL THERAPY LLC
Active
Other names
Kodiak Physical Therapy
Organization subpart
No
Provider details
NPI number
Authorized official
DOV IWANISKI DPT (OWNER)
(732) 724-3720
Entity
Organization
Contact information
Practice address
702 N BEERS ST STE 3, HOLMDEL, NJ 07733-1510
(732) 724-3720
(732) 724-3723
Mailing address
12 TAFT AVE, LAKEWOOD, NJ 08701-5664
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Enumeration date
09/30/2024
Last updated
09/30/2024
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