=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255525283
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KATHLEEN MARY DREYFUSS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/03/2007
-----------------------------------------------------
Last Update Date | 09/03/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8 KRISTINA CT
-----------------------------------------------------
City | MONROE TOWNSHIP
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08831-3750
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-337-6995
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8 KRISTINA CT
-----------------------------------------------------
City | MONROE TOWNSHIP
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08831-3750
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-337-6995
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2251E1300X
-----------------------------------------------------
Taxonomy Name | Clinical Electrophysiology Physical Therapist
-----------------------------------------------------
License Number | QA04216
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------