Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 40QA01676700 | NJ |
NPI | 1003303942 |
---|---|
Provider Name | Suvidha Bansal |
First Address | Toms River, NJ 08753-6316 |
Second Address | Toms River, NJ 08753-6316 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2018 |
Last Update Date | 17/04/2018 |