Provider Demographics
NPI:1679917215
Name:AGONOY LU, RODERICK (PT)
Entity Type:Individual
Prefix:MR
First Name:RODERICK
Middle Name:
Last Name:AGONOY LU
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 GREYHOUND CT
Mailing Address - Street 2:
Mailing Address - City:KENDALL PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08824-1492
Mailing Address - Country:US
Mailing Address - Phone:732-599-9310
Mailing Address - Fax:
Practice Address - Street 1:23 GREYHOUND CT
Practice Address - Street 2:
Practice Address - City:KENDALL PARK
Practice Address - State:NJ
Practice Address - Zip Code:08824-1492
Practice Address - Country:US
Practice Address - Phone:732-599-9310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-25
Last Update Date:2014-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJPTQAOOO7498225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist