Provider Demographics
NPI:1942380548
Name:HUGHES, KATHLEEN MARIE (MPT)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:MARIE
Last Name:HUGHES
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:152 CENTRAL AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:CLARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07066-1115
Mailing Address - Country:US
Mailing Address - Phone:732-499-4540
Mailing Address - Fax:732-499-4577
Practice Address - Street 1:152 CENTRAL AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:CLARK
Practice Address - State:NJ
Practice Address - Zip Code:07066-1115
Practice Address - Country:US
Practice Address - Phone:732-499-4540
Practice Address - Fax:732-499-4577
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2009-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00859800225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3024601Medicaid
NJ3024601Medicaid