Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 40QA01541700 | NJ |
NPI | 1033658000 |
---|---|
Provider Name | Jessica Tallini |
First Address | Matawan, NJ 07747-1129 |
Second Address | Matawan, NJ 07747-1129 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/02/2017 |
Last Update Date | 23/02/2017 |