Provider Demographics
NPI:1427478924
Name:PAVLICK, ELISE (DPT)
Entity type:Individual
Prefix:
First Name:ELISE
Middle Name:
Last Name:PAVLICK
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:ELISE
Other - Middle Name:
Other - Last Name:PAOLANTONIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:67 LACEY RD
Mailing Address - Street 2:SUITES 8-12
Mailing Address - City:WHITING
Mailing Address - State:NJ
Mailing Address - Zip Code:08759-2912
Mailing Address - Country:US
Mailing Address - Phone:732-849-9600
Mailing Address - Fax:
Practice Address - Street 1:67 LACEY RD STE 8-12
Practice Address - Street 2:
Practice Address - City:WHITING
Practice Address - State:NJ
Practice Address - Zip Code:08759-2912
Practice Address - Country:US
Practice Address - Phone:732-849-0700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-23
Last Update Date:2016-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01548500225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist