Healthcare Provider Details

I. General information

NPI: 1992045553
Provider Name (Legal Business Name): DEVON MARIE OHLENSCHLAEGER PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DEVON GUSTAFSON

II. Dates (important events)

Enumeration Date: 02/19/2013
Last Update Date: 10/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7408 LAKE WORTH RD SUITE 500
LAKE WORTH FL
33467-2502
US

IV. Provider business mailing address

11 EAGLE ROCK AVE 201
EAST HANOVER NJ
07936-3167
US

V. Phone/Fax

Practice location:
  • Phone: 561-432-3693
  • Fax: 561-432-3694
Mailing address:
  • Phone: 973-887-9000
  • Fax: 973-887-3816

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: