Provider Demographics
NPI:1629211339
Name:UMALI, LAWRENCE KERWIN A (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:KERWIN A
Last Name:UMALI
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 NORTH WOOD AVENUE
Mailing Address - Street 2:
Mailing Address - City:LINDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07036
Mailing Address - Country:US
Mailing Address - Phone:908-474-9444
Mailing Address - Fax:908-620-3744
Practice Address - Street 1:901 N WOOD AVE
Practice Address - Street 2:
Practice Address - City:LINDEN
Practice Address - State:NJ
Practice Address - Zip Code:07036-4039
Practice Address - Country:US
Practice Address - Phone:908-474-9444
Practice Address - Fax:908-620-3744
Is Sole Proprietor?:No
Enumeration Date:2009-04-10
Last Update Date:2009-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01307300174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ40QA01307300OtherPHYSICAL THERAPIST LICENSE