Provider Demographics
NPI:1871315390
Name:PUNLA, CHALLIZ ANNE ENTRINA (DPT)
Entity type:Individual
Prefix:DR
First Name:CHALLIZ ANNE
Middle Name:ENTRINA
Last Name:PUNLA
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 1:39 CHANNING DR
Mailing Address - Street 2:
Mailing Address - City:RINGWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07456-2506
Mailing Address - Country:US
Mailing Address - Phone:201-736-8611
Mailing Address - Fax:
Practice Address - Street 1:360 ESSEX ST STE 202
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-8566
Practice Address - Country:US
Practice Address - Phone:551-996-3830
Practice Address - Fax:210-498-1201
Is Sole Proprietor?:No
Enumeration Date:2024-10-28
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01177400225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist