Healthcare Provider Details

I. General information

NPI: 1194817833
Provider Name (Legal Business Name): JANE AVILES PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400 US HIGHWAY 9
FREEHOLD NJ
07728-1383
US

IV. Provider business mailing address

5 COBB CT
MANALAPAN NJ
07726-2833
US

V. Phone/Fax

Practice location:
  • Phone: 732-625-2200
  • Fax:
Mailing address:
  • Phone: 732-462-7177
  • Fax: 732-462-7177

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA00870500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: