Provider Demographics
NPI:1194817833
Name:AVILES, JANE (PT)
Entity Type:Individual
Prefix:MRS
First Name:JANE
Middle Name:
Last Name:AVILES
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 1:5 COBB CT
Mailing Address - Street 2:
Mailing Address - City:MANALAPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726-2833
Mailing Address - Country:US
Mailing Address - Phone:732-462-7177
Mailing Address - Fax:732-462-7177
Practice Address - Street 1:4400 US HIGHWAY 9
Practice Address - Street 2:
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-1383
Practice Address - Country:US
Practice Address - Phone:732-625-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00870500225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist