Healthcare Provider Details

I. General information

NPI: 1699872770
Provider Name (Legal Business Name): JEANNE A DELLA VECCHIA PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 CAMPUS DR STE A
MOUNT HOLLY NJ
08060-9604
US

IV. Provider business mailing address

347 BROAD ST
MOUNT HOLLY NJ
08060-1414
US

V. Phone/Fax

Practice location:
  • Phone: 609-261-3434
  • Fax:
Mailing address:
  • Phone: 609-702-1990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number40QB00214500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: