Provider Demographics
NPI:1477671071
Name:POBLETE, GERALDINE BATTUNG (LPT)
Entity Type:Individual
Prefix:
First Name:GERALDINE
Middle Name:BATTUNG
Last Name:POBLETE
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 LONG MEADOW DRIVE
Mailing Address - Street 2:
Mailing Address - City:MULLICA HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08062
Mailing Address - Country:US
Mailing Address - Phone:856-478-6723
Mailing Address - Fax:
Practice Address - Street 1:160 BILLOWS DRIVE
Practice Address - Street 2:
Practice Address - City:MOUNT ROYAL
Practice Address - State:NJ
Practice Address - Zip Code:08061
Practice Address - Country:US
Practice Address - Phone:856-478-6723
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2016-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT011328L2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic