Provider Demographics
NPI:1790034551
Name:PERCOPO, CAROLYN (DPT)
Entity Type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:
Last Name:PERCOPO
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 1:1372 ROUTE 9
Mailing Address - Street 2:BUILDING # 2
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-4038
Mailing Address - Country:US
Mailing Address - Phone:732-240-9296
Mailing Address - Fax:732-240-9297
Practice Address - Street 1:1037 ROUTE 70
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NJ
Practice Address - Zip Code:08759-5806
Practice Address - Country:US
Practice Address - Phone:732-408-1800
Practice Address - Fax:732-408-0704
Is Sole Proprietor?:No
Enumeration Date:2012-09-07
Last Update Date:2012-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA014584002251G0304X, 2251S0007X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports