Provider Demographics
NPI:1710858063
Name:ISLAND PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:ISLAND PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:OHALLORAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:610-745-9860
Mailing Address - Street 1:128 E 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH WILDWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08260-5802
Mailing Address - Country:US
Mailing Address - Phone:610-745-9860
Mailing Address - Fax:
Practice Address - Street 1:100 E 6TH AVE
Practice Address - Street 2:
Practice Address - City:NORTH WILDWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08260-5822
Practice Address - Country:US
Practice Address - Phone:610-745-9860
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-17
Last Update Date:2025-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty