Provider Demographics
NPI:1356556716
Name:PETITJEAN, DEBORAH (MS PT)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:PETITJEAN
Suffix:
Gender:F
Credentials:MS PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 FERN AVE
Mailing Address - Street 2:
Mailing Address - City:CHATHAM
Mailing Address - State:NJ
Mailing Address - Zip Code:07928-2717
Mailing Address - Country:US
Mailing Address - Phone:973-635-6031
Mailing Address - Fax:
Practice Address - Street 1:330 SOUTH AVE
Practice Address - Street 2:
Practice Address - City:FANWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07023-1325
Practice Address - Country:US
Practice Address - Phone:908-233-3720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00707400225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist