Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 40QA01437400 | NM |
NPI | 1003182932 |
---|---|
Provider Name | Jamie L Desena |
First Address | East Hanover, NJ 07936-3167 |
Second Address | Sparta, NJ 07871-1941 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2012 |
Last Update Date | 12/01/2018 |