Provider Demographics
NPI:1508945601
Name:VENERACION-FULE, MELIZA CARMELA UMALI (PT)
Entity Type:Individual
Prefix:
First Name:MELIZA CARMELA
Middle Name:UMALI
Last Name:VENERACION-FULE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MELIZA CARMELA
Other - Middle Name:UMALI
Other - Last Name:VENERACION
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:314 LINDEN AVE
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07305-1974
Mailing Address - Country:US
Mailing Address - Phone:201-467-6207
Mailing Address - Fax:
Practice Address - Street 1:242 10TH ST
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07302-1406
Practice Address - Country:US
Practice Address - Phone:201-795-2499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01086400225100000X
NY023736-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist