Provider Demographics
NPI:1669948865
Name:BARRY, LARA J (PT)
Entity type:Individual
Prefix:MRS
First Name:LARA
Middle Name:J
Last Name:BARRY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3204 SCENIC CT
Mailing Address - Street 2:
Mailing Address - City:DENVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07834-3481
Mailing Address - Country:US
Mailing Address - Phone:862-579-8666
Mailing Address - Fax:
Practice Address - Street 1:65 N SUSSEX ST
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NJ
Practice Address - Zip Code:07801-3949
Practice Address - Country:US
Practice Address - Phone:973-361-5200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-16
Last Update Date:2018-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01180800225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist