Individual
RHIA VISTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
1719 MAIN ST, LAKE COMO, NJ 07719-3097
(732) 894-9200
(732) 894-9202
Mailing address
1719 MAIN ST, LAKE COMO, NJ 07719-3097
(732) 894-9200
(732) 894-9202
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
40QB00338300
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
40QB00338300
PTA LICENSE
NJ
Enumeration date
03/23/2017
Last updated
03/23/2017
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