Provider Demographics
NPI:1942304050
Name:CARECCIA, KIMBERLEY ANNE (MSPT)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLEY
Middle Name:ANNE
Last Name:CARECCIA
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:KIMBERLEY
Other - Middle Name:
Other - Last Name:STIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:129 WOODLAND AVE
Mailing Address - Street 2:
Mailing Address - City:RAMSEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07446
Mailing Address - Country:US
Mailing Address - Phone:201-962-3134
Mailing Address - Fax:
Practice Address - Street 1:361 GARBALDI AVE
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:NJ
Practice Address - Zip Code:07644
Practice Address - Country:US
Practice Address - Phone:973-777-9040
Practice Address - Fax:973-777-5262
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist