Provider Demographics
NPI:1568993483
Name:DETTWILER, ANNEGRET (PT, EDD)
Entity Type:Individual
Prefix:DR
First Name:ANNEGRET
Middle Name:
Last Name:DETTWILER
Suffix:
Gender:F
Credentials:PT, EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 RIDGEVIEW RD
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-7668
Mailing Address - Country:US
Mailing Address - Phone:609-497-3927
Mailing Address - Fax:
Practice Address - Street 1:325 RIDGEVIEW RD
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-7668
Practice Address - Country:US
Practice Address - Phone:609-497-3927
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-22
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA004773002251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics