Basic Information
| Provider Information | |||||||||
| NPI: | 1316294085 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WIDMER | ||||||||
| FirstName: | LAURA | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | P.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1200 EAGLE AVE | ||||||||
| Address2: | |||||||||
| City: | OCEAN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 077127631 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7326606220 | ||||||||
| FaxNumber: | 7326606221 | ||||||||
| Practice Location | |||||||||
| Address1: | 294 APPLEGARTH RD | ||||||||
| Address2: | |||||||||
| City: | MONROE TOWNSHIP | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 088313754 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6094951888 | ||||||||
| FaxNumber: | 6096624467 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/13/2012 | ||||||||
| LastUpdateDate: | 08/13/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 40QA00344900 | NJ | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 2251X0800X | 40QA00344900 | NJ | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Orthopedic |
No ID Information.