Provider Demographics
NPI:1508605312
Name:LOUIS FELISMA, ROSELINE
Entity type:Individual
Prefix:
First Name:ROSELINE
Middle Name:
Last Name:LOUIS FELISMA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:734 N BROAD ST APT T1734
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07208-2312
Mailing Address - Country:US
Mailing Address - Phone:561-814-9237
Mailing Address - Fax:
Practice Address - Street 1:734 N BROAD ST APT T1
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07208-2333
Practice Address - Country:US
Practice Address - Phone:561-814-9237
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-21
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QB00404200225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant