Provider Demographics
NPI:1497004154
Name:PAZARAS, VERNA LANE (PT)
Entity Type:Individual
Prefix:
First Name:VERNA
Middle Name:LANE
Last Name:PAZARAS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:VERNA
Other - Middle Name:CHRISTINE
Other - Last Name:LANE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT,
Mailing Address - Street 1:170 MORRIS AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:LONG BRANCH
Mailing Address - State:NJ
Mailing Address - Zip Code:07740-8214
Mailing Address - Country:US
Mailing Address - Phone:732-222-2900
Mailing Address - Fax:
Practice Address - Street 1:170 MORRIS AVE
Practice Address - Street 2:SUITE B
Practice Address - City:LONG BRANCH
Practice Address - State:NJ
Practice Address - Zip Code:07740-8214
Practice Address - Country:US
Practice Address - Phone:732-222-2900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-09
Last Update Date:2012-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00903900225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist