Provider Demographics
NPI:1649435702
Name:KINSELLA, EDWARD J (DPT)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:J
Last Name:KINSELLA
Suffix:
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 1:4056 QUAKERBRIDGE RD
Mailing Address - Street 2:SUITE 111
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08648-4779
Mailing Address - Country:US
Mailing Address - Phone:609-588-8600
Mailing Address - Fax:
Practice Address - Street 1:4056 QUAKERBRIDGE RD
Practice Address - Street 2:SUITE 111
Practice Address - City:LAWRENCEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08648-4779
Practice Address - Country:US
Practice Address - Phone:609-588-8600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-28
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT019439225100000X
NJ40QA01294800225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist