Provider Demographics
NPI:1699968917
Name:JOHN, LIGY S (PT)
Entity type:Individual
Prefix:MRS
First Name:LIGY
Middle Name:S
Last Name:JOHN
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 1:927 COUNTRY CLUB DR
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-5615
Mailing Address - Country:US
Mailing Address - Phone:201-766-1689
Mailing Address - Fax:
Practice Address - Street 1:927 COUNTRY CLUB DR
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-5615
Practice Address - Country:US
Practice Address - Phone:201-766-1689
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-21
Last Update Date:2007-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01235400225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist