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General NPI Number Information
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NPI Number | 1750480471
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Entity Type | Organization
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Legal Business Name | PERFECT FORMATION PHYSICAL THERAPY
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Dates
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Enumeration Date | 09/21/2006
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Last Update Date | 10/14/2010
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Provider Practice Location Address
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Address Line | 411 US HIGHWAY 206 SUITE 16
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City | HILLSBOROUGH
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State | NJ
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Zip | 08844-5024
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Country | US
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Telephone | 908-874-4522
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Fax | 908-874-4531
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Provider Business Mailing Address
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Address Line | 411 US HIGHWAY 206 SUITE 16
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City | HILLSBOROUGH
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State | NJ
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Zip | 08844-5024
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Country | US
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Telephone | 908-874-4522
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Fax | 908-874-4531
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Authorized Official
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Title or Position | DIRECTOR / OWNER
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Name | DR. CORINNE MARIE SICOLA
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Credential | DPT
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Telephone | 908-874-4522
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 40QA00926000
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License Number State | NJ
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