Provider Demographics
NPI:1720012685
Name:FRANCO, MARIO A (PHYSICAL THARAPIST)
Entity Type:Individual
Prefix:
First Name:MARIO
Middle Name:A
Last Name:FRANCO
Suffix:
Gender:M
Credentials:PHYSICAL THARAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:232 LAUREL HEIGHTS DR
Mailing Address - Street 2:4
Mailing Address - City:BRIDGETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08302
Mailing Address - Country:US
Mailing Address - Phone:856-455-9730
Mailing Address - Fax:856-455-5165
Practice Address - Street 1:232 LAUREL HEIGHTS DR
Practice Address - Street 2:4
Practice Address - City:BRIDGETON
Practice Address - State:NJ
Practice Address - Zip Code:08302
Practice Address - Country:US
Practice Address - Phone:856-455-9730
Practice Address - Fax:856-455-5165
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00401200225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
143994Medicare ID - Type Unspecified