MEDICARE: MS. LARA ELIZABETH VIGGIANO MPT

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	QA00900100	NJ

General Provider Information

NPI Number	:	1831167089
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LARA ELIZABETH VIGGIANO MPT

Provider Business Mailing Address
First Line	:	100 CREEK CROSSING BLVD
Second Line	:	SUITE 107
City	:	HAINESPORT
State	:	NJ
Zip	:	08036-2765
Country	:	US
Telephone Number	:	609-265-0700
Fax Number	:	609-265-0708

Provider Business Practice Location Address
First Line	:	100 CREEK CROSSING BLVD
Second Line	:	SUITE 107
City	:	HAINESPORT
State	:	NJ
Zip	:	08036-2765
Country	:	US
Telephone Number	:	609-265-0700
Fax Number	:	609-265-0708

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

Provider Enumeration Date	:	03/12/2006
Last Update Date	:	07/08/2007

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