Basic Information
| Provider Information | |||||||||
| NPI: | 1689758146 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ATZERT | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | F. | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | PTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 97 JILL CT | ||||||||
| Address2: | |||||||||
| City: | MONMOUTH JUNCTION | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 088522621 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7329210319 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3228 ROUTE 27 | ||||||||
| Address2: | |||||||||
| City: | KENDALL PARK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 08824 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7322970032 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/24/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | 40QB00247400 | NJ | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.