Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2251G0304X | Physical Therapist - Geriatrics | 40QA01541600 | NJ |
N | 2251S0007X | Physical Therapist - Sports | 40QA01541600 | NJ |
Y | 2251X0800X | Physical Therapist - Orthopedic | 40QA01541600 | NJ |
NPI | 1033534896 |
---|---|
Provider Name | Mr. Christopher J Macintosh |
First Address | Toms River, NJ 08755-4038 |
Second Address | Toms River, NJ 08755-4038 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/03/2014 |
Last Update Date | 03/03/2014 |