Organization
EDGE WELLNESS AND PHYSICAL THERAPY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LAWRENCE KIM PT, DPT, OCS (CEO)
(201) 785-7486
Entity
Organization
Contact information
Practice address
2 EXECUTIVE DR STE C1, FORT LEE, NJ 07024-3308
(201) 785-7486
(201) 771-3024
Mailing address
80 E RTE 4 STE 100, PARAMUS, NJ 07652-2647
(201) 845-3000
(201) 843-2035
Taxonomy
Speciality
Code
Description
License number
State
2081S0010X
Sports Medicine (Physical Medicine & Rehabilitation) Physician
Primary
—
—
261QP2000X
Physical Therapy Clinic/Center
—
—
Other
Enumeration date
06/30/2021
Last updated
06/30/2021
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