Provider Demographics
NPI:1427243914
Name:GO, JACQUILINE O (PTRP, RPT)
Entity type:Individual
Prefix:
First Name:JACQUILINE
Middle Name:O
Last Name:GO
Suffix:
Gender:
Credentials:PTRP, RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1307 WOODHOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:WEST DEPTFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08066-2305
Mailing Address - Country:US
Mailing Address - Phone:856-579-7628
Mailing Address - Fax:
Practice Address - Street 1:1307 WOODHOLLOW DR
Practice Address - Street 2:
Practice Address - City:WEST DEPTFORD
Practice Address - State:NJ
Practice Address - Zip Code:08066-2305
Practice Address - Country:US
Practice Address - Phone:856-579-7628
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-08
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist