Provider Demographics
NPI:1265296560
Name:RUNCO, JACLYN GARGIULO (PT, DPT)
Entity type:Individual
Prefix:
First Name:JACLYN
Middle Name:GARGIULO
Last Name:RUNCO
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:JACLYN
Other - Middle Name:
Other - Last Name:GARGIULO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1457 GREYSTONE DR
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15206-1157
Mailing Address - Country:US
Mailing Address - Phone:845-926-7210
Mailing Address - Fax:
Practice Address - Street 1:5770 BAUM BLVD STE 100
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15206-3763
Practice Address - Country:US
Practice Address - Phone:412-661-0400
Practice Address - Fax:412-661-1803
Is Sole Proprietor?:No
Enumeration Date:2024-02-08
Last Update Date:2025-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT032039225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist