MEDICARE: LAUREN M. CONCA P.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	40QA00315300	NJ

General Provider Information

NPI Number	:	1609893544
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREN M. CONCA P.T.

Provider Business Mailing Address
First Line	:	3155 STATE ROUTE 10
Second Line	:	SUITE 112
City	:	DENVILLE
State	:	NJ
Zip	:	07834-3492
Country	:	US
Telephone Number	:	973-366-2600
Fax Number	:	973-366-7874

Provider Business Practice Location Address
First Line	:	3155 STATE ROUTE 10
Second Line	:	SUITE 112
City	:	DENVILLE
State	:	NJ
Zip	:	07834-3492
Country	:	US
Telephone Number	:	973-366-2600
Fax Number	:	973-366-7874

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/16/2006
Last Update Date	:	07/08/2007

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Directions to “ LAUREN M. CONCA P.T.” Practice Location

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