Provider Demographics
NPI:1104272236
Name:TASHJIAN, FLORENCE L (PT)
Entity type:Individual
Prefix:MRS
First Name:FLORENCE
Middle Name:L
Last Name:TASHJIAN
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 1:62 BEECHWOOD RD
Mailing Address - Street 2:
Mailing Address - City:LINCROFT
Mailing Address - State:NJ
Mailing Address - Zip Code:07738-1101
Mailing Address - Country:US
Mailing Address - Phone:732-747-5679
Mailing Address - Fax:
Practice Address - Street 1:1350 CAMPUS PKWY
Practice Address - Street 2:
Practice Address - City:WALL TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:07753-6821
Practice Address - Country:US
Practice Address - Phone:732-295-8215
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-07
Last Update Date:2016-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00582700225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist