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General NPI Number Information
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NPI Number | 1679018782
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Entity Type | Individual
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Provider Name | KATELYN L CIANCIARULO DPT
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Gender | Female
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Dates
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Enumeration Date | 12/28/2016
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Last Update Date | 09/06/2019
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Provider Practice Location Address
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Address Line | 1131 BROAD ST STE 301
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City | SHREWSBURY
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State | NJ
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Zip | 07702-4370
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Country | US
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Telephone | 732-440-1596
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Fax | 732-440-1597
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Provider Business Mailing Address
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Address Line | 1131 BROAD ST STE 301
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City | SHREWSBURY
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State | NJ
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Zip | 07702-4370
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Country | US
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Telephone | 732-440-1596
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Fax | 732-440-1597
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 22718
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 40QA01813200
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License Number State | NJ
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