Provider Demographics
NPI:1184826745
Name:POLLICOVE, JODI EILEEN (PTA)
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:EILEEN
Last Name:POLLICOVE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 HUMMINGBIRD CT
Mailing Address - Street 2:
Mailing Address - City:MARLBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:07746-2511
Mailing Address - Country:US
Mailing Address - Phone:732-761-3037
Mailing Address - Fax:732-761-3038
Practice Address - Street 1:36 HUMMINGBIRD CT
Practice Address - Street 2:
Practice Address - City:MARLBORO
Practice Address - State:NJ
Practice Address - Zip Code:07746-2511
Practice Address - Country:US
Practice Address - Phone:732-761-3037
Practice Address - Fax:732-761-3038
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QB00160100225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant