Provider Demographics
NPI:1790842789
Name:LALLY, STEVEN JAMES (PT)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:JAMES
Last Name:LALLY
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 1:1035 HOOPER AVE
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-8355
Mailing Address - Country:US
Mailing Address - Phone:732-505-2028
Mailing Address - Fax:732-349-2405
Practice Address - Street 1:9 MULE RD
Practice Address - Street 2:SUITE E-2
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-5043
Practice Address - Country:US
Practice Address - Phone:732-473-1666
Practice Address - Fax:732-473-1601
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QAO0518800225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ094914Medicare PIN
NJ094917UNEMedicare UPIN