Provider Demographics
NPI:1942311766
Name:FERRETTA, BRYAN C (PT)
Entity type:Individual
Prefix:MR
First Name:BRYAN
Middle Name:C
Last Name:FERRETTA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 CASELLA WAY
Mailing Address - Street 2:
Mailing Address - City:WOOLWICH
Mailing Address - State:NJ
Mailing Address - Zip Code:08085
Mailing Address - Country:US
Mailing Address - Phone:856-467-1116
Mailing Address - Fax:
Practice Address - Street 1:207 S KINGS HWY
Practice Address - Street 2:STE 7; HEARTLAND REHABILITATION SERVICES OF NEW JERSEY
Practice Address - City:WOOLWICH
Practice Address - State:NJ
Practice Address - Zip Code:08085
Practice Address - Country:US
Practice Address - Phone:856-795-9515
Practice Address - Fax:856-795-5418
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00916100225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist