Provider Demographics
NPI:1588005193
Name:SENGEBUSH, CARA ANNE
Entity Type:Individual
Prefix:
First Name:CARA
Middle Name:ANNE
Last Name:SENGEBUSH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 TOBY TER
Mailing Address - Street 2:
Mailing Address - City:MONROE TWP
Mailing Address - State:NJ
Mailing Address - Zip Code:08831-8564
Mailing Address - Country:US
Mailing Address - Phone:732-991-1522
Mailing Address - Fax:
Practice Address - Street 1:555 E BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:WY
Practice Address - Zip Code:83001-8640
Practice Address - Country:US
Practice Address - Phone:307-739-1864
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-11
Last Update Date:2013-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY1482225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist