Provider Demographics
NPI:1679598650
Name:FURTADO, JOHN LOUIS (ATC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:LOUIS
Last Name:FURTADO
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 JACKIE DR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08648-2108
Mailing Address - Country:US
Mailing Address - Phone:609-512-1559
Mailing Address - Fax:
Practice Address - Street 1:PRINCETON UNIVERSITY DILLON GYM A30
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08544-0001
Practice Address - Country:US
Practice Address - Phone:609-258-3518
Practice Address - Fax:609-258-7045
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MT000723002255A2300X
NJ40QA00690400225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer