Provider Demographics
NPI:1427697432
Name:GALLUCCI, DEVAN
Entity type:Individual
Prefix:
First Name:DEVAN
Middle Name:
Last Name:GALLUCCI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 BETHANY ROAD
Mailing Address - Street 2:BUILDING 4, SUITE 53
Mailing Address - City:HAZLET
Mailing Address - State:NJ
Mailing Address - Zip Code:07730
Mailing Address - Country:US
Mailing Address - Phone:732-264-6106
Mailing Address - Fax:732-264-1117
Practice Address - Street 1:4505 ROUTE 9 N
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:NJ
Practice Address - Zip Code:07731-3380
Practice Address - Country:US
Practice Address - Phone:732-901-5553
Practice Address - Fax:732-901-1131
Is Sole Proprietor?:No
Enumeration Date:2019-12-23
Last Update Date:2019-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist