Provider Demographics
NPI:1285061861
Name:LANAHAN, ALISSA (DPT)
Entity type:Individual
Prefix:
First Name:ALISSA
Middle Name:
Last Name:LANAHAN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:ALISSA
Other - Middle Name:
Other - Last Name:PRENTICE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:4 WALTER E FORAN BLVD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:FLEMINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08822-4664
Mailing Address - Country:US
Mailing Address - Phone:908-237-0000
Mailing Address - Fax:908-237-0001
Practice Address - Street 1:4 WALTER E FORAN BLVD
Practice Address - Street 2:SUITE 203
Practice Address - City:FLEMINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08822-4664
Practice Address - Country:US
Practice Address - Phone:908-237-0000
Practice Address - Fax:908-237-0001
Is Sole Proprietor?:No
Enumeration Date:2013-09-27
Last Update Date:2016-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01507900225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist