Provider Demographics
NPI:1164294153
Name:SACCO, LAUREN JULIA (PT, DPT)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:JULIA
Last Name:SACCO
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:791 OLD RARITAN RD
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-1015
Mailing Address - Country:US
Mailing Address - Phone:732-887-5656
Mailing Address - Fax:
Practice Address - Street 1:791 OLD RARITAN RD
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-1015
Practice Address - Country:US
Practice Address - Phone:732-887-5656
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-24
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01388100225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist