Provider Demographics
NPI:1366590598
Name:MONTEMAYOR MATEO, DJHOANA (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:MRS
First Name:DJHOANA
Middle Name:
Last Name:MONTEMAYOR MATEO
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 1:453 GLENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-6405
Mailing Address - Country:US
Mailing Address - Phone:201-357-4906
Mailing Address - Fax:
Practice Address - Street 1:453 GLENWOOD AVE
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-6405
Practice Address - Country:US
Practice Address - Phone:201-357-4906
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01138200225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist