Provider Demographics
NPI:1538565114
Name:DIAS, JOSEPH (PTA)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:DIAS
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 COLUMBIA DR
Mailing Address - Street 2:APT. 1B
Mailing Address - City:BRIDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:08807-3405
Mailing Address - Country:US
Mailing Address - Phone:908-296-1781
Mailing Address - Fax:
Practice Address - Street 1:333 ELMWOOD AVE
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07040-2491
Practice Address - Country:US
Practice Address - Phone:973-313-2104
Practice Address - Fax:973-996-2319
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-10
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QB00282400225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant