Provider Demographics
NPI:1235256660
Name:VERGARA, ELAINE R (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:R
Last Name:VERGARA
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 HASTINGS DR
Mailing Address - Street 2:
Mailing Address - City:GALLOWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08205-4680
Mailing Address - Country:US
Mailing Address - Phone:609-442-0916
Mailing Address - Fax:
Practice Address - Street 1:113 HASTINGS DR
Practice Address - Street 2:
Practice Address - City:GALLOWAY
Practice Address - State:NJ
Practice Address - Zip Code:08205-4680
Practice Address - Country:US
Practice Address - Phone:609-442-0916
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJPT40QA01149900225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist