Provider Demographics
NPI:1861790065
Name:CACAO, HAROLD BOY PICACHE (PT)
Entity type:Individual
Prefix:MR
First Name:HAROLD BOY
Middle Name:PICACHE
Last Name:CACAO
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 1:1894 RUTHERFORD ST
Mailing Address - Street 2:
Mailing Address - City:RAHWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:07065-5305
Mailing Address - Country:US
Mailing Address - Phone:732-910-7909
Mailing Address - Fax:
Practice Address - Street 1:1894 RUTHERFORD ST
Practice Address - Street 2:
Practice Address - City:RAHWAY
Practice Address - State:NJ
Practice Address - Zip Code:07065-5305
Practice Address - Country:US
Practice Address - Phone:732-910-7909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-11
Last Update Date:2011-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033157225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist