Provider Demographics
NPI:1548478605
Name:MUSSAWAR, MARYSE (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:MRS
First Name:MARYSE
Middle Name:
Last Name:MUSSAWAR
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 ANDREA DR
Mailing Address - Street 2:
Mailing Address - City:NORTH CALDWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07006-4730
Mailing Address - Country:US
Mailing Address - Phone:973-256-2504
Mailing Address - Fax:
Practice Address - Street 1:44 ANDREA DR
Practice Address - Street 2:
Practice Address - City:NORTH CALDWELL
Practice Address - State:NJ
Practice Address - Zip Code:07006-4730
Practice Address - Country:US
Practice Address - Phone:973-256-2504
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00465500225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist