Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 40QB00293500 | NJ |
NPI | 1003152919 |
---|---|
Provider Name | Ms. Michele Marie Pittenger |
First Address | Florence, NJ 08518-1905 |
Second Address | Mountainside, NJ 07092-2590 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/12/2012 |
Last Update Date | 20/12/2012 |