Provider Demographics
NPI:1558087130
Name:VALENCIA PHYSICAL THERAPY, PLLC
Entity Type:Organization
Organization Name:VALENCIA PHYSICAL THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MEREDITH
Authorized Official - Middle Name:
Authorized Official - Last Name:IZZICUPO
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, SCS
Authorized Official - Phone:201-317-9683
Mailing Address - Street 1:733 TURNPIKE ST # 112
Mailing Address - Street 2:
Mailing Address - City:NORTH ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01845-6137
Mailing Address - Country:US
Mailing Address - Phone:978-328-0768
Mailing Address - Fax:
Practice Address - Street 1:1565 MAIN ST
Practice Address - Street 2:
Practice Address - City:TEWKSBURY
Practice Address - State:MA
Practice Address - Zip Code:01876-2085
Practice Address - Country:US
Practice Address - Phone:978-328-0768
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-17
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty