Provider Demographics
NPI:1568615920
Name:KARDOS, JOHANNA MARCELA (DPT)
Entity Type:Individual
Prefix:MRS
First Name:JOHANNA
Middle Name:MARCELA
Last Name:KARDOS
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 1:181 SANTA CRUZ RD
Mailing Address - Street 2:
Mailing Address - City:TUCKERTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08087-4251
Mailing Address - Country:US
Mailing Address - Phone:908-279-4446
Mailing Address - Fax:
Practice Address - Street 1:801 TILTON RD
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:NJ
Practice Address - Zip Code:08225-1265
Practice Address - Country:US
Practice Address - Phone:609-645-0505
Practice Address - Fax:609-641-3532
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-29
Last Update Date:2017-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ1-0002387225100000X
PAPT019624225100000X
NJ40QA01421900225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist