Provider Demographics
NPI:1659116325
Name:IDRISSI, LENA (DPT)
Entity type:Individual
Prefix:DR
First Name:LENA
Middle Name:
Last Name:IDRISSI
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 FOX HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-2923
Mailing Address - Country:US
Mailing Address - Phone:267-560-4633
Mailing Address - Fax:
Practice Address - Street 1:2902 130 N
Practice Address - Street 2:
Practice Address - City:BURLINGTON COUNTY
Practice Address - State:NJ
Practice Address - Zip Code:08075
Practice Address - Country:US
Practice Address - Phone:856-461-8331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-26
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA02259300225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist