Provider Demographics
NPI:1063741411
Name:SAN JUAN, MARIA EILEEN VILORIA (MSPT)
Entity type:Individual
Prefix:MS
First Name:MARIA EILEEN
Middle Name:VILORIA
Last Name:SAN JUAN
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20203 BAINBRIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-4867
Mailing Address - Country:US
Mailing Address - Phone:908-907-0036
Mailing Address - Fax:732-298-6150
Practice Address - Street 1:20203 BAINBRIDGE WAY
Practice Address - Street 2:
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-4867
Practice Address - Country:US
Practice Address - Phone:908-907-0036
Practice Address - Fax:732-298-6150
Is Sole Proprietor?:No
Enumeration Date:2009-12-14
Last Update Date:2009-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00969900225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist