Provider Demographics
NPI:1245503994
Name:SMELAS, LISA BACIGALUPI (PT)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:BACIGALUPI
Last Name:SMELAS
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 1:141 RUMSON RD
Mailing Address - Street 2:
Mailing Address - City:LITTLE SILVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07739-1333
Mailing Address - Country:US
Mailing Address - Phone:732-530-2025
Mailing Address - Fax:
Practice Address - Street 1:141 RUMSON RD
Practice Address - Street 2:
Practice Address - City:LITTLE SILVER
Practice Address - State:NJ
Practice Address - Zip Code:07739-1333
Practice Address - Country:US
Practice Address - Phone:732-530-2025
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-10
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA006975002251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics