Provider Demographics
NPI:1457711046
Name:MUIR, AGNES (PT)
Entity Type:Individual
Prefix:MRS
First Name:AGNES
Middle Name:
Last Name:MUIR
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:AGNES
Other - Middle Name:PAGDANGANAN
Other - Last Name:MUIR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1321 RIVER AVENUE APT A
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-5623
Mailing Address - Country:US
Mailing Address - Phone:732-766-9189
Mailing Address - Fax:
Practice Address - Street 1:1321 RIVER AVENUE APARTMENT A
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-5623
Practice Address - Country:US
Practice Address - Phone:732-766-9189
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-25
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA013116002251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics