Provider Demographics
NPI:1386780799
Name:FREEMAN, DARRYL LOUIS (PT)
Entity type:Individual
Prefix:MR
First Name:DARRYL
Middle Name:LOUIS
Last Name:FREEMAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:189 FRANKLIN AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:NUTLEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07110-2997
Mailing Address - Country:US
Mailing Address - Phone:973-235-9585
Mailing Address - Fax:973-235-9740
Practice Address - Street 1:189 FRANKLIN AVE STE 2
Practice Address - Street 2:
Practice Address - City:NUTLEY
Practice Address - State:NJ
Practice Address - Zip Code:07110-2997
Practice Address - Country:US
Practice Address - Phone:973-235-9585
Practice Address - Fax:973-235-9740
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00383700225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist