Organization
GAME CHANGER PHYSICAL THERAPY PC
Active
Organization
GAME CHANGER PHYSICAL THERAPY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEREMY PASTER DPT (PHYSICAL THERAPIST)
(732) 740-5384
Entity
Organization
Contact information
Practice address
1215 WYCKOFF RD, WALL TOWNSHIP, NJ 07727-3914
(732) 740-5384
(212) 223-0198
Mailing address
1215 WYCKOFF RD, WALL TOWNSHIP, NJ 07727-3914
(732) 740-5384
(212) 223-0198
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
40QA01688000
LICENSE
NJ
Enumeration date
04/09/2020
Last updated
04/09/2020
Update your record
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