Provider Demographics
NPI:1861627267
Name:MAGNO, ANALYN B (PT)
Entity Type:Individual
Prefix:MRS
First Name:ANALYN
Middle Name:B
Last Name:MAGNO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:ANALYN
Other - Middle Name:B
Other - Last Name:MAGNO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:1210 REVOIR DRIVE
Mailing Address - Street 2:
Mailing Address - City:RAHWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:07065
Mailing Address - Country:US
Mailing Address - Phone:973-641-0679
Mailing Address - Fax:
Practice Address - Street 1:217 HERGESELL AVE
Practice Address - Street 2:
Practice Address - City:MAYWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07607-1140
Practice Address - Country:US
Practice Address - Phone:973-641-0679
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-28
Last Update Date:2009-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01084700225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist