Individual
CHARISSE KATHERINE SIRACUSA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT,DPT
Contact information
Practice address
1719 MAIN ST, LAKE COMO, NJ 07719-3097
(732) 894-9200
Mailing address
1719 MAIN ST, LAKE COMO, NJ 07719-3097
(732) 894-9200
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
40QA01855600
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
40QA01855600
NJ LICENSE
NJ
Enumeration date
05/08/2019
Last updated
05/08/2019
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