Healthcare Provider Details

I. General information

NPI: 1518211911
Provider Name (Legal Business Name): AMANDA HELEN LARAUS P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: AMANDA HELEN LARAUS PHYSICAL THERAPIST

II. Dates (important events)

Enumeration Date: 11/07/2012
Last Update Date: 11/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 W MAIN ST
FREEHOLD NJ
07728-2537
US

IV. Provider business mailing address

901 W MAIN ST
FREEHOLD NJ
07728-2537
US

V. Phone/Fax

Practice location:
  • Phone: 732-297-2700
  • Fax: 732-294-2568
Mailing address:
  • Phone: 732-637-6303
  • Fax: 732-294-2568

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number40QAOO590700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: