Provider Demographics
NPI:1902932981
Name:MCMENAMY, CARLA P (PT)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:P
Last Name:MCMENAMY
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 1:66 W GILBERT ST
Mailing Address - Street 2:2ND FL.
Mailing Address - City:TINTON FALLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-4947
Mailing Address - Country:US
Mailing Address - Phone:732-212-0051
Mailing Address - Fax:732-212-0052
Practice Address - Street 1:66 W GILBERT ST
Practice Address - Street 2:
Practice Address - City:TINTON FALLS
Practice Address - State:NJ
Practice Address - Zip Code:07701-4947
Practice Address - Country:US
Practice Address - Phone:732-212-0051
Practice Address - Fax:732-212-0052
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00908700225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ110342V2NMedicare PIN
NJ110342XKSMedicare PIN
NJ119598XKSMedicare PIN