Provider Demographics
NPI:1558819581
Name:JOSEPHSEN, KELLIANNE (DPT)
Entity Type:Individual
Prefix:DR
First Name:KELLIANNE
Middle Name:
Last Name:JOSEPHSEN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:258 RUNNYMEDE RD
Mailing Address - Street 2:
Mailing Address - City:WEST CALDWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07006-8117
Mailing Address - Country:US
Mailing Address - Phone:201-396-9712
Mailing Address - Fax:
Practice Address - Street 1:177 VALLEY ST
Practice Address - Street 2:
Practice Address - City:SOUTH ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07079-2836
Practice Address - Country:US
Practice Address - Phone:973-761-0077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-20
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01671700225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist