Healthcare Provider Details

I. General information

NPI: 1477671071
Provider Name (Legal Business Name): GERALDINE BATTUNG POBLETE LPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 11/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 BILLOWS DRIVE
MOUNT ROYAL NJ
08061
US

IV. Provider business mailing address

303 LONG MEADOW DRIVE
MULLICA HILL NJ
08062
US

V. Phone/Fax

Practice location:
  • Phone: 856-478-6723
  • Fax:
Mailing address:
  • Phone: 856-478-6723
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT011328L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: