Provider Demographics
NPI:1265727671
Name:JANNE, KALIE (PT)
Entity type:Individual
Prefix:
First Name:KALIE
Middle Name:
Last Name:JANNE
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 STIRLING RD STE 400
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:NJ
Mailing Address - Zip Code:07059-5778
Mailing Address - Country:US
Mailing Address - Phone:908-251-5888
Mailing Address - Fax:908-251-5903
Practice Address - Street 1:76 STIRLING RD STE 400
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:NJ
Practice Address - Zip Code:07059-5778
Practice Address - Country:US
Practice Address - Phone:908-251-5888
Practice Address - Fax:908-251-5903
Is Sole Proprietor?:No
Enumeration Date:2011-06-14
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01394800225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist