Provider Demographics
NPI:1184819674
Name:THOONKUZHY, REENA J (PT)
Entity Type:Individual
Prefix:MRS
First Name:REENA
Middle Name:J
Last Name:THOONKUZHY
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 1:313 E WESTFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:ROSELLE PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07204-2317
Mailing Address - Country:US
Mailing Address - Phone:908-620-1991
Mailing Address - Fax:908-620-9777
Practice Address - Street 1:313 E WESTFIELD AVE
Practice Address - Street 2:
Practice Address - City:ROSELLE PARK
Practice Address - State:NJ
Practice Address - Zip Code:07204-2317
Practice Address - Country:US
Practice Address - Phone:908-620-1991
Practice Address - Fax:908-620-9777
Is Sole Proprietor?:No
Enumeration Date:2007-09-08
Last Update Date:2007-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00720900225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ025571Medicare PIN