Individual provider Active NPI

Mark F Schwall, PT

  • Physical Therapist
  • Forked River, NJ
National Provider Identifier
1255418067
Registry record updated May 10, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
40QA00629000 Issued in NJ
Practice address
640 Lacey Rd
Forked River, NJ 08731-2100
Phone
(609) 756-5800
Fax
(888) 974-0986
NPI assigned
Nov 1, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 10, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 40QA00629000 NJ Primary

Addresses

Primary practice location

640 Lacey Rd
Forked River, NJ 08731-2100

Mailing address

67 Lacey Rd
Whiting, NJ 08759-2912
Phone (732) 849-0080

Other practice location 1

1594 Route 9 Ste 2
Toms River, NJ 08755-3280
Phone (732) 557-9319

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040526000712 NJ Practitioner - Physical Therapist in Private Practice 3173504180 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 1986
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ivyrehab Network IncGroup PAC ID 3476539776, 658 clinicians

Practice addresses (Care Compare)

300 Princeton Hightstown Rd
Suite 201
East Windsor, NJ 08520-1411
Phone (609) 426-4442

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
40QA00629000NJMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Ivyrehab Network Inc. Physical Therapist Current Accepting new patients
Ivyrehab Network Inc Physical Therapist CurrentSince Mar 3, 2020 Accepting new patients
Ivyrehab Network, Inc. Physical Therapist CurrentSince Mar 3, 2020 Accepting new patients

Locations

731 Lacey Rd
Ste 3
Forked River, NJ 08731
Phone (609) 242-6780

640 Lacey Rd
Forked River, NJ 08731
Phone (609) 756-5800

640 Lacey Rd
Ste A
Forked River, NJ 08731
Phone (609) 756-5800

1377 Motor Pkwy
Ste 307
Ronkonkoma, NY 11749

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1525910400000",
    "number": "1255418067",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "67 LACEY RD",
            "city": "WHITING",
            "state": "NJ",
            "postal_code": "087592912",
            "telephone_number": "732-849-0080",
            "fax_number": "732-849-1088"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "640 LACEY RD",
            "city": "FORKED RIVER",
            "state": "NJ",
            "postal_code": "087312100",
            "telephone_number": "609-756-5800",
            "fax_number": "888-974-0986"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1594 Route 9 Ste 2",
            "address_purpose": "LOCATION",
            "city": "Toms River",
            "state": "NJ",
            "postal_code": "087553280",
            "country_code": "US",
            "telephone_number": "732-557-9319",
            "fax_number": "732-557-9519",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SCHWALL",
        "first_name": "MARK",
        "middle_name": "F",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-01",
        "last_updated": "2018-05-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NJ",
            "license": "40QA00629000",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Forked River, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.