Provider Demographics
NPI:1871641308
Name:THEMANS-LOSS, MARGALIET S (PT)
Entity Type:Individual
Prefix:
First Name:MARGALIET
Middle Name:S
Last Name:THEMANS-LOSS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76 HEATHERHILL RD
Mailing Address - Street 2:
Mailing Address - City:CRESSKILL
Mailing Address - State:NJ
Mailing Address - Zip Code:07626-1021
Mailing Address - Country:US
Mailing Address - Phone:201-362-1292
Mailing Address - Fax:
Practice Address - Street 1:66 N VAN BRUNT ST
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-2703
Practice Address - Country:US
Practice Address - Phone:201-568-2044
Practice Address - Fax:201-568-7455
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00391000225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ020539Medicare ID - Type Unspecified