Provider Demographics
NPI:1972558260
Name:BACOLOD, JOSE JR (RPT)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:
Last Name:BACOLOD
Suffix:JR
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 N 5TH ST STE 106
Mailing Address - Street 2:
Mailing Address - City:SADDLE BROOK
Mailing Address - State:NJ
Mailing Address - Zip Code:07663-6156
Mailing Address - Country:US
Mailing Address - Phone:201-250-8808
Mailing Address - Fax:201-250-8809
Practice Address - Street 1:15 N STREET SUITE 106
Practice Address - Street 2:
Practice Address - City:SADDLE BROOK
Practice Address - State:NJ
Practice Address - Zip Code:07663-9999
Practice Address - Country:US
Practice Address - Phone:201-250-8808
Practice Address - Fax:201-250-8809
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-24
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01062200225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist