Provider Demographics
NPI:1801842166
Name:BOENNING, LAURIE (PT, MA)
Entity Type:Individual
Prefix:MS
First Name:LAURIE
Middle Name:
Last Name:BOENNING
Suffix:
Gender:F
Credentials:PT, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2417 BRIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:POINT PLEASANT BORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08742-4334
Mailing Address - Country:US
Mailing Address - Phone:732-701-9320
Mailing Address - Fax:732-701-9321
Practice Address - Street 1:2417 BRIDGE AVE
Practice Address - Street 2:
Practice Address - City:POINT PLEASANT BORO
Practice Address - State:NJ
Practice Address - Zip Code:08742-4334
Practice Address - Country:US
Practice Address - Phone:732-701-9320
Practice Address - Fax:732-701-9321
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-26
Last Update Date:2011-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJQA04593225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2133806OtherAETNA
NJ2133806OtherAETNA