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NPI Code Detail

MEDICARE: LARRY MARTIN LEMASTERS PTA

MEDICARE: LARRY MARTIN LEMASTERS PTA
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
1225200000XPhysical Therapy Assistant40QB00140100NJ

General Provider Information

NPI Number : 1629260476
Entity Type Code : Individual
Provider Name (Legal Business Name) : LARRY MARTIN LEMASTERS PTA
Provider Business Mailing Address
First Line : 398 POMTON AVENUE
Second Line : THE CANTERBURY
City : CEDAR GROVE
State : NJ
Zip : 07009
Country : US
Telephone Number : 973-239-7600
Fax Number : 973-239-5864
Provider Business Practice Location Address
First Line : 398 POMPTON AVE
Second Line :
City : CEDAR GROVE
State : NJ
Zip : 07009-1813
Country : US
Telephone Number : 973-239-7600
Fax Number : 973-239-5864
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/15/2007
Last Update Date : 08/15/2007

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Directions to “ LARRY MARTIN LEMASTERS PTA” Practice Location

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