Provider Demographics
NPI:1184656456
Name:SAJOUS-THEAGENE, MICHELE (PT)
Entity Type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:
Last Name:SAJOUS-THEAGENE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:MICHELE
Other - Middle Name:
Other - Last Name:SAJOUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1050 GALLOPING HILL RD
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-7983
Mailing Address - Country:US
Mailing Address - Phone:908-206-2230
Mailing Address - Fax:908-206-2237
Practice Address - Street 1:200 S ORANGE AVE
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-5817
Practice Address - Country:US
Practice Address - Phone:973-322-7500
Practice Address - Fax:973-322-7543
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00875100225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist