Individual
ANTHONY FREDERICK IVY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHYSICAL THERAPIST
Contact information
Practice address
61 W JIMMIE LEEDS RD, POMONA, NJ 08240-9102
(609) 652-7000
Mailing address
6826 WASHINGTON AVE, EGG HARBOR TOWNSHIP, NJ 08234-3818
(609) 431-3195
Taxonomy
Speciality
Code
Description
License number
State
2251G0304X
Geriatric Physical Therapist
40QA00450600
NJ
2251X0800X
Orthopedic Physical Therapist
Primary
40QA00450600
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40QA00450600
—
NJ
Enumeration date
02/13/2023
Last updated
02/13/2023
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