Provider Demographics
NPI:1598246118
Name:POLTRICITSKY, SHAWNA (PT, DPT, OCS, PCES)
Entity Type:Individual
Prefix:
First Name:SHAWNA
Middle Name:
Last Name:POLTRICITSKY
Suffix:
Gender:F
Credentials:PT, DPT, OCS, PCES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:147 HURD ST
Mailing Address - Street 2:
Mailing Address - City:MINE HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:07803-3209
Mailing Address - Country:US
Mailing Address - Phone:908-310-1899
Mailing Address - Fax:
Practice Address - Street 1:794 FRANKLIN AVE STE 204
Practice Address - Street 2:
Practice Address - City:FRANKLIN LAKES
Practice Address - State:NJ
Practice Address - Zip Code:07417-1399
Practice Address - Country:US
Practice Address - Phone:201-891-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-22
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01812100208100000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation