Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251S0007X | Physical Therapist - Sports | 40QA01321400 | NJ |
NPI | 1225260144 |
---|---|
Provider Name | Stephen Alexander Bade |
First Address | Tinton Falls, NJ 07712 |
Second Address | Tinton Falls, NJ 07712 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2009 |
Last Update Date | 05/12/2011 |