Provider Demographics
NPI:1417607086
Name:CORPUZ, JOAN CAGARA (PT, DPT)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:CAGARA
Last Name:CORPUZ
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 LAUREL DR
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-4403
Mailing Address - Country:US
Mailing Address - Phone:201-696-1396
Mailing Address - Fax:
Practice Address - Street 1:31 LAUREL DR
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-4403
Practice Address - Country:US
Practice Address - Phone:201-696-1396
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-26
Last Update Date:2022-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA012431002251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ40QA01243100OtherPHYSICAL THERAPY BOARD OF NJ/ DCA