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NPI Code Detail

MEDICARE: DR. KEVIN PICARDO DPT

MEDICARE: DR. KEVIN PICARDO DPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist40QA01517200NJ

General Provider Information

NPI Number : 1821423203
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KEVIN PICARDO DPT
Provider Business Mailing Address
First Line : 15 BLOOMFIELD AVE
Second Line :
City : MONTCLAIR
State : NJ
Zip : 07042-4888
Country : US
Telephone Number : 973-744-2770
Fax Number :
Provider Business Practice Location Address
First Line : 15 BLOOMFIELD AVE
Second Line :
City : MONTCLAIR
State : NJ
Zip : 07042-4888
Country : US
Telephone Number : 973-744-2770
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/04/2013
Last Update Date : 09/04/2013

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Directions to “ DR. KEVIN PICARDO DPT” Practice Location

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