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General NPI Number Information
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NPI Number | 1851327258
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Entity Type | Individual
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Provider Name | MARY GRACE FONDEVILLA SEMBRANO PT
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Gender | Female
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Dates
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Enumeration Date | 06/25/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 527 RIVER AVE
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City | LAKEWOOD
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State | NJ
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Zip | 08701
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Country | US
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Telephone | 732-905-0700
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Fax | 732-364-4566
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Provider Business Mailing Address
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Address Line | 16 TULIP COURT
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City | HOWELL
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State | NJ
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Zip | 07731
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Country | US
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Telephone | 843-276-6709
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Fax | 732-202-8773
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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 | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 40QA01021100
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 40QA01021100
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License Number State | NJ
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