=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902828528
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AIMEE LISA FERRAIOLI MPT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/24/2006
-----------------------------------------------------
Last Update Date | 07/24/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 162 JOYSAN TER
-----------------------------------------------------
City | FREEHOLD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07728-9304
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-331-1654
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12 RACHEL CT
-----------------------------------------------------
City | JACKSON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08527-2410
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-513-6464
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 40QA00786800
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------