Organization
AUTHENTIC PHYSICAL THERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TATI B HARSONO PT (PHYSICAL THERAPIST)
(201) 256-3623
Entity
Organization
Contact information
Practice address
265 W GRAND ST, ELIZABETH, NJ 07202-1205
(201) 256-3623
(201) 256-3632
Mailing address
265 W GRAND ST, ELIZABETH, NJ 07202-1205
(201) 256-3623
(201) 256-3632
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
—
—
Other
Enumeration date
06/12/2025
Last updated
07/23/2025
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