Provider Demographics
NPI:1679018782
Name:CIANCIARULO, KATELYN L (DPT)
Entity Type:Individual
Prefix:
First Name:KATELYN
Middle Name:L
Last Name:CIANCIARULO
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:KATELYN
Other - Middle Name:M
Other - Last Name:LYNCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:1131 BROAD ST STE 301
Mailing Address - Street 2:
Mailing Address - City:SHREWSBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:07702-4370
Mailing Address - Country:US
Mailing Address - Phone:732-440-1596
Mailing Address - Fax:732-440-1597
Practice Address - Street 1:1131 BROAD ST STE 301
Practice Address - Street 2:
Practice Address - City:SHREWSBURY
Practice Address - State:NJ
Practice Address - Zip Code:07702-4370
Practice Address - Country:US
Practice Address - Phone:732-440-1596
Practice Address - Fax:732-440-1597
Is Sole Proprietor?:No
Enumeration Date:2016-12-28
Last Update Date:2019-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA22718225100000X
NJ40QA01813200225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist