Provider Demographics
NPI:1538421359
Name:ROLDAN-TORRETTI, MARY GRACE PALO (DPT)
Entity type:Individual
Prefix:
First Name:MARY GRACE
Middle Name:PALO
Last Name:ROLDAN-TORRETTI
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:MARY GRACE
Other - Middle Name:PALO
Other - Last Name:ROLDAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPT
Mailing Address - Street 1:57 PELICAN DR
Mailing Address - Street 2:
Mailing Address - City:BAYVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08721-1654
Mailing Address - Country:US
Mailing Address - Phone:732-581-0692
Mailing Address - Fax:
Practice Address - Street 1:20 HOSPITAL DR STE 23
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-6434
Practice Address - Country:US
Practice Address - Phone:732-581-0692
Practice Address - Fax:928-441-4007
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-08
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA012257002251X0800X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic