Provider Demographics
NPI:1114372539
Name:OST, CARLY R
Entity Type:Individual
Prefix:
First Name:CARLY
Middle Name:R
Last Name:OST
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 STRAWBRIDGE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:MOORESTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08057-4602
Mailing Address - Country:US
Mailing Address - Phone:856-677-4000
Mailing Address - Fax:856-234-3014
Practice Address - Street 1:1 ROSSMOOR DR STE 101
Practice Address - Street 2:
Practice Address - City:MONROE TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08831-1596
Practice Address - Country:US
Practice Address - Phone:609-860-9913
Practice Address - Fax:609-860-9915
Is Sole Proprietor?:No
Enumeration Date:2016-05-04
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT028447225100000X
LA10539R225100000X
MA24827225100000X
TX1332917225100000X
VA2305210061225100000X
NJ225100000X
NJ40QA01665000225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist