Provider Demographics
NPI:1669479259
Name:MONTECALVO, KEITH JOSEPH (PT,DPT,OCS,MDT,SFMA)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:JOSEPH
Last Name:MONTECALVO
Suffix:
Gender:M
Credentials:PT,DPT,OCS,MDT,SFMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 STRAWBRIDGE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:MOORESTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08057-4602
Mailing Address - Country:US
Mailing Address - Phone:856-677-4000
Mailing Address - Fax:856-234-3014
Practice Address - Street 1:2123 HIGHWAY 35
Practice Address - Street 2:
Practice Address - City:SEA GIRT
Practice Address - State:NJ
Practice Address - Zip Code:08750-1003
Practice Address - Country:US
Practice Address - Phone:732-449-2001
Practice Address - Fax:732-449-2238
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01087400225100000X, 2251X0800X
NJQA108742251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ085487Medicare ID - Type Unspecified