Provider Demographics
NPI:1548203318
Name:POLICARPIO, DEO GRACE M (PT)
Entity Type:Individual
Prefix:MS
First Name:DEO GRACE
Middle Name:M
Last Name:POLICARPIO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:DEO GRACE
Other - Middle Name:
Other - Last Name:MENDOZA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:217 WATERFORD DR
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08817-1915
Mailing Address - Country:US
Mailing Address - Phone:732-662-1934
Mailing Address - Fax:
Practice Address - Street 1:760 AMBOY AVE
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08837-3224
Practice Address - Country:US
Practice Address - Phone:732-661-1121
Practice Address - Fax:732-661-1151
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01083700225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist