Provider Demographics
NPI:1184845349
Name:FLETCHER, JO MALAHY (DPT)
Entity Type:Individual
Prefix:DR
First Name:JO
Middle Name:MALAHY
Last Name:FLETCHER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:580 MOUNTAIN AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH CALDWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07006-4573
Mailing Address - Country:US
Mailing Address - Phone:619-227-6659
Mailing Address - Fax:
Practice Address - Street 1:635 MADISON AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-1009
Practice Address - Country:US
Practice Address - Phone:212-224-7900
Practice Address - Fax:212-755-5634
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2011-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33137225100000X
NY62 0329042251X0800X
NJ40QA013851002251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist