Provider Demographics
NPI:1346590379
Name:PASERCHIA, STACY L (PT, MPT, TDPT)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:L
Last Name:PASERCHIA
Suffix:
Gender:F
Credentials:PT, MPT, TDPT
Other - Prefix:
Other - First Name:STACY
Other - Middle Name:L
Other - Last Name:POTKULSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:25 CATON TER
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07006-4808
Mailing Address - Country:US
Mailing Address - Phone:732-322-6858
Mailing Address - Fax:
Practice Address - Street 1:151 SUMMIT AVE STE 1
Practice Address - Street 2:
Practice Address - City:SUMMIT
Practice Address - State:NJ
Practice Address - Zip Code:07901-2813
Practice Address - Country:US
Practice Address - Phone:732-322-6858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-18
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA012877002251P0200X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics