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General NPI Number Information
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NPI Number | 1740389840
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Entity Type | Individual
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Provider Name | PATRICK S LALIBERTE PT
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Gender | Male
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Dates
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Enumeration Date | 09/22/2006
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Last Update Date | 11/10/2009
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Provider Practice Location Address
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Address Line | 303 W MAIN ST
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City | FREEHOLD
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State | NJ
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Zip | 07728-4832
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Country | US
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Telephone | 732-431-8900
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Fax | 732-431-0244
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Provider Business Mailing Address
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Address Line | 4175 VETERANS MEMORIAL HWY SUITE 202
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City | RONKONKOMA
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State | NY
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Zip | 11779-7639
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Country | US
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Telephone | 631-580-5200
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Fax | 631-580-5222
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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 | 40QA01182900
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License Number State | NJ
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