Tidewatch Physical Therapy, LLC

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

40QA01328500 Issued in NJ

Legal business name

TIDEWATCH PHYSICAL THERAPY, LLC

Practice address

39 Avenue at the CMN Ste 200a
Shrewsbury, NJ 07702-4587

Phone

(732) 204-7741

NPI assigned

Apr 2, 2017

Organization subpart

No

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

Authorized official

Name

John Blumberger, PT, DPT, MBA

Title

Managing Member

Phone

(732) 204-7741

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1491091200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1498694400000",
    "number": "1992237598",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "39 AVENUE AT THE CMN STE 200A",
            "city": "SHREWSBURY",
            "state": "NJ",
            "postal_code": "077024587"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "39 AVENUE AT THE CMN STE 200A",
            "city": "SHREWSBURY",
            "state": "NJ",
            "postal_code": "077024587",
            "telephone_number": "732-204-7741"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIDEWATCH PHYSICAL THERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-04-02",
        "last_updated": "2017-06-29",
        "status": "A",
        "authorized_official_last_name": "BLUMBERGER",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "732-204-7741",
        "authorized_official_credential": "PT, DPT, MBA"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "NJ",
            "license": "40QA01328500",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physical Therapist in Shrewsbury, NJ
• Providers in Shrewsbury, NJ by specialty
• Physical Therapist in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.