Provider Demographics
NPI:1699872770
Name:DELLA VECCHIA, JEANNE A (PTA)
Entity type:Individual
Prefix:
First Name:JEANNE
Middle Name:A
Last Name:DELLA VECCHIA
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:347 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT HOLLY
Mailing Address - State:NJ
Mailing Address - Zip Code:08060-1414
Mailing Address - Country:US
Mailing Address - Phone:609-702-1990
Mailing Address - Fax:
Practice Address - Street 1:300 CAMPUS DR STE A
Practice Address - Street 2:
Practice Address - City:MOUNT HOLLY
Practice Address - State:NJ
Practice Address - Zip Code:08060-9604
Practice Address - Country:US
Practice Address - Phone:609-261-3434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QB00214500225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ316589Medicare ID - Type Unspecified