Provider Demographics
NPI:1881346484
Name:MUSTAFA, AYESHA H (DPT)
Entity type:Individual
Prefix:DR
First Name:AYESHA
Middle Name:H
Last Name:MUSTAFA
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 1:15 DIX LN
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08648-4844
Mailing Address - Country:US
Mailing Address - Phone:301-525-6341
Mailing Address - Fax:
Practice Address - Street 1:3100 QUAKERBRIDGE RD
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08619-1658
Practice Address - Country:US
Practice Address - Phone:301-525-6341
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-25
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01755000225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ40QA01755000OtherNJ STATE BOARD OF PHYSICAL THERAPY