Provider Demographics
NPI:1518211911
Name:LARAUS, AMANDA HELEN (PT)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:HELEN
Last Name:LARAUS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:AMANDA
Other - Middle Name:HELEN
Other - Last Name:LARAUS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHYSICAL THERAPIST
Mailing Address - Street 1:901 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-2537
Mailing Address - Country:US
Mailing Address - Phone:732-637-6303
Mailing Address - Fax:732-294-2568
Practice Address - Street 1:901 W MAIN ST
Practice Address - Street 2:
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-2537
Practice Address - Country:US
Practice Address - Phone:732-297-2700
Practice Address - Fax:732-294-2568
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-07
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QAOO5907002251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic