Provider Demographics
NPI:1225120124
Name:DESANTIS, JOANNA M (PT)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:M
Last Name:DESANTIS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JOANNA
Other - Middle Name:MARIE
Other - Last Name:FRALEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:24 MACARTHUR BLVD
Mailing Address - Street 2:
Mailing Address - City:SOMERS POINT
Mailing Address - State:NJ
Mailing Address - Zip Code:08244-1776
Mailing Address - Country:US
Mailing Address - Phone:609-927-1991
Mailing Address - Fax:609-926-0075
Practice Address - Street 1:24 MACARTHUR BLVD
Practice Address - Street 2:
Practice Address - City:SOMERS POINT
Practice Address - State:NJ
Practice Address - Zip Code:08244-1776
Practice Address - Country:US
Practice Address - Phone:609-927-1991
Practice Address - Fax:609-926-0075
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01555900225100000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYDD3043Medicare ID - Type Unspecified