Healthcare Provider Details

I. General information

NPI: 1245358092
Provider Name (Legal Business Name): JESSETTE AREOLA MASANQUE PHYSICAL THERAPIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 DEERPARK DR
MONMOUTH JCT NJ
08852-1919
US

IV. Provider business mailing address

11 ROCK RUN RD
EAST WINDSOR NJ
08520-3048
US

V. Phone/Fax

Practice location:
  • Phone: 732-274-1122
  • Fax: 732-274-1991
Mailing address:
  • Phone: 908-208-7456
  • Fax: 609-301-8807

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA00920900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: