Provider Demographics
NPI:1073205241
Name:LINCK, MAUREEN D (PT)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:D
Last Name:LINCK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 HACKENSACK AVE
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-6328
Mailing Address - Country:US
Mailing Address - Phone:732-998-1496
Mailing Address - Fax:
Practice Address - Street 1:411 HACKENSACK AVE
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-6328
Practice Address - Country:US
Practice Address - Phone:732-998-1496
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-24
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ0040QA06176225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist