Provider Demographics
NPI:1417908476
Name:PODOLSKY, TRACEY J (MPT, CLT-LANA)
Entity Type:Individual
Prefix:MS
First Name:TRACEY
Middle Name:J
Last Name:PODOLSKY
Suffix:
Gender:F
Credentials:MPT, CLT-LANA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 ALDRICH RD UNIT 1E
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07731-1978
Mailing Address - Country:US
Mailing Address - Phone:732-222-8556
Mailing Address - Fax:
Practice Address - Street 1:504 ALDRICH RD UNIT 1E
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:NJ
Practice Address - Zip Code:07731-1978
Practice Address - Country:US
Practice Address - Phone:732-222-8556
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2021-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00948400225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ093231UGVMedicare ID - Type Unspecified