Healthcare Provider Details

I. General information

NPI: 1255662375
Provider Name (Legal Business Name): SUSAN M KARL PHYSICAL THERAPIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2010
Last Update Date: 02/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 LAUREL AVE
KEANSBURG NJ
07734-1125
US

IV. Provider business mailing address

263 ROSEWOOD LN
PORT READING NJ
07064-1240
US

V. Phone/Fax

Practice location:
  • Phone: 732-787-8100
  • Fax:
Mailing address:
  • Phone: 732-213-3372
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA00556100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: