Most Relevant Information
Provider Data
| NPI Number: | 1003308206 |
| Provider Name: | SHANIECE DEGAZON DPT |
| Entity Type: | Individual |
| Taxonomy Code: | 225100000X |
| Specialty: | Physical Therapist |
| License Number: | 40QA01788400 |
Most Important Dates
| Enumeration Date: | 06/04/2018 |
| Last Updated: | 06/04/2018 |
Provider Practice Location
45 SOUTH AVE W STE 101
CRANFORD
NJ
070162686
Practice Location Phone/Fax
| Phone: | 9087097300 |
| Fax: |
Provider Mailing Location
91 WOODHAVEN DR
WAYNE
NJ
074705166
Provider Mailing Phone/Fax
| Phone: | 6095585333 |
| Fax: |