Provider Demographics
NPI:1326475419
Name:RACIMO, DARYLLE
Entity Type:Individual
Prefix:
First Name:DARYLLE
Middle Name:
Last Name:RACIMO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 RIDGE RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:DAYTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08810-3300
Mailing Address - Country:US
Mailing Address - Phone:732-230-3076
Mailing Address - Fax:866-862-4631
Practice Address - Street 1:118 MAIN ST
Practice Address - Street 2:
Practice Address - City:SUCCASUNNA
Practice Address - State:NJ
Practice Address - Zip Code:07876-1385
Practice Address - Country:US
Practice Address - Phone:973-584-4000
Practice Address - Fax:973-933-4510
Is Sole Proprietor?:No
Enumeration Date:2013-10-03
Last Update Date:2013-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01161600225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist