Provider Demographics
NPI:1699898510
Name:BADALUCCO, LYDIA M (PT)
Entity type:Individual
Prefix:
First Name:LYDIA
Middle Name:M
Last Name:BADALUCCO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1108 DOOLITTLE DR
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:08807-7028
Mailing Address - Country:US
Mailing Address - Phone:908-218-1780
Mailing Address - Fax:
Practice Address - Street 1:1108 DOOLITTLE DR
Practice Address - Street 2:
Practice Address - City:BRIDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:08807-7028
Practice Address - Country:US
Practice Address - Phone:908-218-1780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00612000225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist