Provider Demographics
NPI:1245598382
Name:KRIZ-CORTES, LORRAINE (PTA)
Entity Type:Individual
Prefix:
First Name:LORRAINE
Middle Name:
Last Name:KRIZ-CORTES
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:364 ACACIA RD
Mailing Address - Street 2:
Mailing Address - City:SCOTCH PLAINS
Mailing Address - State:NJ
Mailing Address - Zip Code:07076-2002
Mailing Address - Country:US
Mailing Address - Phone:908-389-1984
Mailing Address - Fax:
Practice Address - Street 1:364 ACACIA RD
Practice Address - Street 2:
Practice Address - City:SCOTCH PLAINS
Practice Address - State:NJ
Practice Address - Zip Code:07076-2002
Practice Address - Country:US
Practice Address - Phone:908-389-1984
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-26
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QB00008600225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant