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General NPI Number Information
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NPI Number | 1083216733
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Entity Type | Individual
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Provider Name | RENEE REARDON PTA
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Gender | Female
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Dates
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Enumeration Date | 11/09/2020
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Last Update Date | 11/09/2020
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Provider Practice Location Address
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Address Line | 2630 E CHESTNUT AVE STE C5
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City | VINELAND
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State | NJ
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Zip | 08361-8400
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Country | US
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Telephone | 856-692-1483
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Fax |
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Provider Business Mailing Address
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Address Line | 900 ROUTE 9 N STE 410
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City | WOODBRIDGE
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State | NJ
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Zip | 07095-1003
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Country | US
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Telephone | 201-801-7141
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 40QB00128800
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License Number State | NJ
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