Provider Demographics
NPI:1275779944
Name:VERTICCHIO, THOMAS ERMINIO (MS, PT)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:ERMINIO
Last Name:VERTICCHIO
Suffix:
Gender:M
Credentials:MS, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:MATAWAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07747-3208
Mailing Address - Country:US
Mailing Address - Phone:718-986-7466
Mailing Address - Fax:
Practice Address - Street 1:9 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:MATAWAN
Practice Address - State:NJ
Practice Address - Zip Code:07747-3208
Practice Address - Country:US
Practice Address - Phone:718-986-7466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-30
Last Update Date:2008-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020047-12251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics