Individual
MRS. KAREN LYNN TYSONVONDERHEYDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
2 HILLSIDE AVE, MOUNT ARLINGTON, NJ 07856
(973) 601-0988
Mailing address
154 SANDSHORE ROAD, BUDD LAKE, NJ 07828
(973) 224-1050
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
PTA40QB00180800
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00180800
NEW JERSEY STATE OF PHYSICAL THERAPY
NJ
Enumeration date
02/03/2012
Last updated
02/03/2012
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