Provider Demographics
NPI:1770625394
Name:PATULLO, LAURIANNE (PT)
Entity type:Individual
Prefix:MRS
First Name:LAURIANNE
Middle Name:
Last Name:PATULLO
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 1:25 POLHEMUS DR
Mailing Address - Street 2:
Mailing Address - City:HILLSBOROUGH
Mailing Address - State:NJ
Mailing Address - Zip Code:08844-1808
Mailing Address - Country:US
Mailing Address - Phone:908-281-6653
Mailing Address - Fax:
Practice Address - Street 1:109 ORCHARD RD
Practice Address - Street 2:
Practice Address - City:SKILLMAN
Practice Address - State:NJ
Practice Address - Zip Code:08558-2611
Practice Address - Country:US
Practice Address - Phone:908-431-9500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJQA065662251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics