Provider Demographics
NPI:1326108044
Name:RECTO, DAVE ALBERT TRINIDAD (PT)
Entity Type:Individual
Prefix:
First Name:DAVE ALBERT
Middle Name:TRINIDAD
Last Name:RECTO
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 1:325 RARITAN AVE APT 2A
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08904-2701
Mailing Address - Country:US
Mailing Address - Phone:732-249-9026
Mailing Address - Fax:
Practice Address - Street 1:2186 STATE ROUTE 27
Practice Address - Street 2:
Practice Address - City:NORTH BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08902-1137
Practice Address - Country:US
Practice Address - Phone:732-951-2440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJPT40QA01147800225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist