=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306591896
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOANNE TRICARICO MPT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/14/2022
-----------------------------------------------------
Last Update Date | 02/14/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 210 SUMMIT AVE STE A1A
-----------------------------------------------------
City | MONTVALE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07645-1500
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-746-9888
-----------------------------------------------------
Fax | 201-746-9889
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 676 EAST DR
-----------------------------------------------------
City | ORADELL
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07649-1212
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 291-452-2617
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 40QA00670700
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------