Provider Demographics
NPI:1508933805
Name:KOERING, LOIS (MSPT, ATC)
Entity Type:Individual
Prefix:MRS
First Name:LOIS
Middle Name:
Last Name:KOERING
Suffix:
Gender:F
Credentials:MSPT, ATC
Other - Prefix:MISS
Other - First Name:LOIS
Other - Middle Name:
Other - Last Name:FARRELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSPT, ATC
Mailing Address - Street 1:870 TUSKA AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSGROVE
Mailing Address - State:NJ
Mailing Address - Zip Code:08318-4262
Mailing Address - Country:US
Mailing Address - Phone:508-958-5833
Mailing Address - Fax:
Practice Address - Street 1:1051 W SHERMAN AVE
Practice Address - Street 2:
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-6931
Practice Address - Country:US
Practice Address - Phone:856-696-5656
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9462255A2300X
MA8021225100000X
NJ40QA01281100225100000X
NJ25MT001459002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer