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General NPI Number Information
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NPI Number | 1457888091
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Entity Type | Organization
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Legal Business Name | LIFE PT PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 05/14/2017
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Last Update Date | 05/14/2017
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Provider Practice Location Address
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Address Line | 525 ROUTE 70 STE A6
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City | LAKEWOOD
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State | NJ
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Zip | 08701-5847
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Country | US
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Telephone | 732-534-4794
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Fax |
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Provider Business Mailing Address
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Address Line | 525 ROUTE 70 STE A6
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City | LAKEWOOD
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State | NJ
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Zip | 08701-5847
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CHAYA ENGLARD
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Credential | DPT
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Telephone | 732-534-4794
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 40QA01464000
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License Number State | NJ
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