Provider Demographics
NPI:1093732075
Name:PABLO, MARIE J. (PT)
Entity Type:Individual
Prefix:
First Name:MARIE J.
Middle Name:
Last Name:PABLO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JOSETTE
Other - Middle Name:C
Other - Last Name:PABLO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:1 DIAMOND HILL RD
Mailing Address - Street 2:
Mailing Address - City:BERKELEY HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:07922-2104
Mailing Address - Country:US
Mailing Address - Phone:908-277-8936
Mailing Address - Fax:908-673-7336
Practice Address - Street 1:1 DIAMOND HILL RD
Practice Address - Street 2:
Practice Address - City:BERKELEY HEIGHTS
Practice Address - State:NJ
Practice Address - Zip Code:07922-2104
Practice Address - Country:US
Practice Address - Phone:908-277-8936
Practice Address - Fax:908-673-7336
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJQA00950600225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist