Provider Demographics
NPI:1386761401
Name:SENTMAN, LAURIE MARIE (PTA)
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:MARIE
Last Name:SENTMAN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:541 S BRENTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-2718
Mailing Address - Country:US
Mailing Address - Phone:856-222-1603
Mailing Address - Fax:
Practice Address - Street 1:541 S BRENTWOOD DR
Practice Address - Street 2:
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054-2718
Practice Address - Country:US
Practice Address - Phone:856-222-1603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QB00124200225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant