Provider Demographics
NPI:1477089118
Name:MEDORE, LINDA LORIO (PT)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:LORIO
Last Name:MEDORE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:
Other - Last Name:PEMBERTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:17 CANDOUR CT
Mailing Address - Street 2:
Mailing Address - City:HACKETTSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07840-4535
Mailing Address - Country:US
Mailing Address - Phone:908-601-5400
Mailing Address - Fax:
Practice Address - Street 1:17 CANDOUR CT
Practice Address - Street 2:
Practice Address - City:HACKETTSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07840-4535
Practice Address - Country:US
Practice Address - Phone:908-601-5400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-01
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00237700225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ40QA00237700OtherNJ PHYSICAL THERAPIST LICENSE NUMBER