Basic Information
| Provider Information | |||||||||
| NPI: | 1356556716 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PETITJEAN | ||||||||
| FirstName: | DEBORAH | ||||||||
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| Credential: | MS PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16 FERN AVE | ||||||||
| Address2: | |||||||||
| City: | CHATHAM | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 079282717 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9736356031 | ||||||||
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| Practice Location | |||||||||
| Address1: | 330 SOUTH AVE | ||||||||
| Address2: | |||||||||
| City: | FANWOOD | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070231325 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9082333720 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/11/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 40QA00707400 | NJ | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.