Healthcare Provider Details

I. General information

NPI: 1548534183
Provider Name (Legal Business Name): DOLORES M MCLAUGHLIN DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/29/2012
Last Update Date: 12/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 VICTORIA ST
GLASSBORO NJ
08028-2278
US

IV. Provider business mailing address

1 FEDERAL ST
CAMDEN NJ
08103-1088
US

V. Phone/Fax

Practice location:
  • Phone: 856-536-1475
  • Fax:
Mailing address:
  • Phone: 856-356-4924
  • Fax: 856-356-4793

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT020349
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA01602900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: