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Provider Information for 1376995977

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know


Gender: FEMALE

Individual NPI: 1376995977

Calendar   Last Updated:  2021-07-16
  Certification Date:  2021-07-16


Name Value
NPI 1376995977
Enumeration Date 2016-07-07
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address PO BOX 416495
BOSTON, MA 02241-6495
United States

Phone: 142-944-0509 | Fax:
View Map External Link
Primary Practice Address 19 MULE RD
TOMS RIVER, NJ 08755-5061
United States

Phone: 914-294-4050 | Fax:
View Map External Link
Secondary Practice Address 600 MULE RD
TOMS RIVER, NJ 08757-6460
United States

Phone: 732-505-1300 | Fax: 732-505-1301
View Map External Link

Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Primary Taxonomy Selected Taxonomy State License Number
Yes 225100000X - Physical Therapist NJ 40QA01456600