Provider Demographics
NPI:1558036376
Name:GAETANO, MACKENZIE (DPT)
Entity Type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:
Last Name:GAETANO
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:665 EAST AVE
Mailing Address - Street 2:
Mailing Address - City:FRANKLINVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08322-3149
Mailing Address - Country:US
Mailing Address - Phone:856-676-3917
Mailing Address - Fax:
Practice Address - Street 1:520 BECKETT RD STE 200
Practice Address - Street 2:
Practice Address - City:SWEDESBORO
Practice Address - State:NJ
Practice Address - Zip Code:08085-1732
Practice Address - Country:US
Practice Address - Phone:856-467-3421
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-13
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA02029000225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist