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Organization
TIDEWATCH PHYSICAL THERAPY, LLC
Active
Organization
TIDEWATCH PHYSICAL THERAPY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN BLUMBERGER PT, DPT, MBA (MANAGING MEMBER)
(732) 204-7741
Entity
Organization
Contact information
Practice address
39 AVENUE AT THE CMN STE 200A, SHREWSBURY, NJ 07702-4587
(732) 204-7741
Mailing address
39 AVENUE AT THE CMN STE 200A, SHREWSBURY, NJ 07702-4587
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
40QA01328500
NJ
Other
Enumeration date
04/02/2017
Last updated
06/29/2017
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