Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | PT02126 | RI |
Y | 2251G0304X | Physical Therapist - Geriatrics | 6738 |
NPI | 1386833499 |
---|---|
Provider Name | Donna M Larue |
First Address | Cherry Hill, NJ 08003-1000 |
Second Address | Cherry Hill, NJ 08003-1000 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/10/2007 |
Last Update Date | 23/04/2013 |