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NPI Code Detail

MEDICARE: MAE LUCILLE EBARDO DEARING PT, DPT

MEDICARE:   MAE LUCILLE EBARDO DEARING  PT, DPT
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
1225100000XPhysical Therapist40QA01122400NJ

General Provider Information

NPI Number : 1699842153
Entity Type Code : Individual
Provider Name (Legal Business Name) : MAE LUCILLE EBARDO DEARING PT, DPT
Provider Business Mailing Address
First Line : 219 SCHERRER ST
Second Line :
City : CRANFORD
State : NJ
Zip : 07016-2526
Country : US
Telephone Number : 551-998-6651
Fax Number :
Provider Business Practice Location Address
First Line : 574 SPRINGFIELD AVE
Second Line :
City : WESTFIELD
State : NJ
Zip : 07090-1001
Country : US
Telephone Number : 908-228-3632
Fax Number : 908-228-3631
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/29/2006
Last Update Date : 07/21/2022

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Directions to “ MAE LUCILLE EBARDO DEARING PT, DPT” Practice Location

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