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1699988220
MARY ANN LIZA SUPAN
MATAWAN, NJ
NPI
1699988220
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
225100000X Physical Therapist
(Licence: NJ 40QA01125400)
Enumeration Date
2007-05-08
Last Update Date
2007-07-08
Business Address
-- MARY ANN LIZA SUPAN
625 STATE ROUTE 34
MATAWAN, NJ 07747-3050
Phone number: 732-888-2400
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Mailing Address
-- MARY ANN LIZA SUPAN
37 RANDOLPH AVE
OLD BRIDGE, NJ 08857-1147
Phone number:
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