Provider Demographics
NPI:1992281232
Name:STRAZZULLO, CARLIE (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:CARLIE
Middle Name:
Last Name:STRAZZULLO
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:CARLIE
Other - Middle Name:
Other - Last Name:FLAKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:175 ROUTE 70 STE 19
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08055-2355
Mailing Address - Country:US
Mailing Address - Phone:609-714-3378
Mailing Address - Fax:
Practice Address - Street 1:175 ROUTE 70 STE 19
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:NJ
Practice Address - Zip Code:08055-2355
Practice Address - Country:US
Practice Address - Phone:609-714-3378
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-18
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJM0109840OtherQUALCARE