Provider Demographics
NPI:1801211768
Name:FELLOWS, LAURA (DPT)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:FELLOWS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:
Other - Last Name:FRENEAUX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:180 TICES LN STE 101
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-1345
Mailing Address - Country:US
Mailing Address - Phone:732-418-7033
Mailing Address - Fax:732-418-7011
Practice Address - Street 1:180 TICES LN STE 101
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-1345
Practice Address - Country:US
Practice Address - Phone:732-418-7033
Practice Address - Fax:732-418-7011
Is Sole Proprietor?:No
Enumeration Date:2014-02-28
Last Update Date:2018-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01541400225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist