Individual
DR. DAVID DE LA FUENTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT, DPT, CSCS
Contact information
Practice address
77 BRANT AVE, SUITE 101, CLARK, NJ 07066-1560
(732) 499-4540
(732) 499-4577
Mailing address
77 BRANT AVE, SUITE 101, CLARK, NJ 07066-1560
(732) 499-4540
(732) 499-4577
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
40QA01170400
NJ
2251X0800X
Orthopedic Physical Therapist
40QA01170400
NJ
Other
Enumeration date
09/05/2006
Last updated
02/07/2011
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