Provider Demographics
NPI:1104044155
Name:CARECCIA PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:CARECCIA PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIIETOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KIMBERLEY
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:CARECCIA
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:973-777-9040
Mailing Address - Street 1:361 GARIBALDI AVENUE
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:NJ
Mailing Address - Zip Code:07644
Mailing Address - Country:US
Mailing Address - Phone:973-777-9040
Mailing Address - Fax:973-777-5262
Practice Address - Street 1:361 GARIBALDI AVE
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:NJ
Practice Address - Zip Code:07644-3709
Practice Address - Country:US
Practice Address - Phone:973-777-9040
Practice Address - Fax:973-777-5262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty