Individual
LUCILLE RENEE DEROSE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
551 W LANCASTER AVE, HAVERFORD, PA 19041-1419
(180) 055-0921
Mailing address
1228 COLUMBIA AVE, NEWFIELD, NJ 08344-9605
(856) 692-2349
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
40QB00091900
NJ
Other
Enumeration date
03/27/2007
Last updated
09/10/2008
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