Provider Demographics
NPI:1649000936
Name:TERMULO, ABELARDO ETHAN III (DPT)
Entity type:Individual
Prefix:
First Name:ABELARDO
Middle Name:ETHAN
Last Name:TERMULO
Suffix:III
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 18TH AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE COMO
Mailing Address - State:NJ
Mailing Address - Zip Code:07719-3043
Mailing Address - Country:US
Mailing Address - Phone:609-865-3884
Mailing Address - Fax:
Practice Address - Street 1:505 18TH AVE
Practice Address - Street 2:
Practice Address - City:LAKE COMO
Practice Address - State:NJ
Practice Address - Zip Code:07719-3043
Practice Address - Country:US
Practice Address - Phone:609-865-3884
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-02
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA02278800225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist