Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 40QA00321600 | NJ |
NPI | 1043379316 |
---|---|
Provider Name | Ms. Laura N Phillips |
First Address | Ringwood, NJ 07456-2968 |
Second Address | Newark, NJ 07101-1709 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/12/2006 |
Last Update Date | 08/07/2007 |