Provider Demographics
NPI:1154442770
Name:PABELLO, JONATHAN (PT)
Entity Type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:
Last Name:PABELLO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1502 RUSTIC DR
Mailing Address - Street 2:APT. 6
Mailing Address - City:OCEAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07712-7472
Mailing Address - Country:US
Mailing Address - Phone:848-219-4303
Mailing Address - Fax:
Practice Address - Street 1:1502 RUSTIC DR
Practice Address - Street 2:APT. 6
Practice Address - City:OCEAN
Practice Address - State:NJ
Practice Address - Zip Code:07712-7472
Practice Address - Country:US
Practice Address - Phone:848-219-4303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJPT40QA01073100225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist