Provider Demographics
NPI:1306006366
Name:DY TIOCO, JESSE JOE SANTOS (PT)
Entity Type:Individual
Prefix:MR
First Name:JESSE JOE
Middle Name:SANTOS
Last Name:DY TIOCO
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 1:9 OAK RIDGE PKWY
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-8001
Mailing Address - Country:US
Mailing Address - Phone:732-608-7606
Mailing Address - Fax:732-608-7606
Practice Address - Street 1:9 OAK RIDGE PKWY
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-8001
Practice Address - Country:US
Practice Address - Phone:732-608-7606
Practice Address - Fax:732-608-7606
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-12
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01167500225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist