Provider Demographics
NPI:1790328292
Name:PACIFICO, JOSHUA (DPT)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:
Last Name:PACIFICO
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 ROUTE 130
Mailing Address - Street 2:
Mailing Address - City:EAST WINDSOR
Mailing Address - State:NJ
Mailing Address - Zip Code:08520-2792
Mailing Address - Country:US
Mailing Address - Phone:609-918-0600
Mailing Address - Fax:609-918-0601
Practice Address - Street 1:400 ROUTE 130
Practice Address - Street 2:
Practice Address - City:EAST WINDSOR
Practice Address - State:NJ
Practice Address - Zip Code:08520-2792
Practice Address - Country:US
Practice Address - Phone:609-918-0600
Practice Address - Fax:609-918-0601
Is Sole Proprietor?:No
Enumeration Date:2019-10-28
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01897700225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist