Provider Demographics
NPI:1477852358
Name:JOSE, SUJA K (PT)
Entity type:Individual
Prefix:MRS
First Name:SUJA
Middle Name:K
Last Name:JOSE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:SUJA
Other - Middle Name:
Other - Last Name:JOSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:150 ORANGE ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003-4704
Mailing Address - Country:US
Mailing Address - Phone:973-632-1172
Mailing Address - Fax:
Practice Address - Street 1:350 BLOOMFIELD AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:BLOOMFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07003-4897
Practice Address - Country:US
Practice Address - Phone:973-632-1172
Practice Address - Fax:973-947-4058
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-18
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01277100225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist