Provider Demographics
NPI:1144548504
Name:LIPANA, LUISITO RAYMUND CRUZ (PT)
Entity type:Individual
Prefix:MR
First Name:LUISITO RAYMUND
Middle Name:CRUZ
Last Name:LIPANA
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 1:1932 COLOGNE AVE
Mailing Address - Street 2:UNIT K-10
Mailing Address - City:MAYS LANDING
Mailing Address - State:NJ
Mailing Address - Zip Code:08330-2441
Mailing Address - Country:US
Mailing Address - Phone:609-271-3438
Mailing Address - Fax:
Practice Address - Street 1:930 CHURCH ST
Practice Address - Street 2:
Practice Address - City:PLEASANTVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08232-4271
Practice Address - Country:US
Practice Address - Phone:609-646-6900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-11
Last Update Date:2010-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJPT40QA01206600225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist