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General NPI Number Information
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NPI Number | 1043505795
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Entity Type | Individual
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Provider Name | LAURA SQUICCIARINI PHYSICAL THERAPIST
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Gender | Female
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Dates
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Enumeration Date | 06/10/2011
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Last Update Date | 01/24/2020
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Provider Practice Location Address
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Address Line | 77 SCHANCK RD SUITE B-11
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City | FREEHOLD
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State | NJ
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Zip | 07728-2964
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Country | US
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Telephone | 732-294-0383
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Fax |
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Provider Business Mailing Address
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Address Line | 70 TRICENTENNIAL DR
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City | FREEHOLD
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State | NJ
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Zip | 07728-5326
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Country | US
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Telephone | 732-294-0383
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 40QA00460300
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 40QA00460300
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License Number State | NJ
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