Provider Demographics
NPI:1043448467
Name:BAGLEY, RENEE
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:
Last Name:BAGLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:RENEE
Other - Middle Name:
Other - Last Name:CHANIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:157 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08809-1337
Mailing Address - Country:US
Mailing Address - Phone:908-684-5800
Mailing Address - Fax:908-684-5606
Practice Address - Street 1:531 ROUTE 57 E
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07882-2440
Practice Address - Country:US
Practice Address - Phone:908-835-1600
Practice Address - Fax:908-835-1601
Is Sole Proprietor?:No
Enumeration Date:2009-06-24
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01177300225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist