Provider Demographics
NPI:1942579396
Name:PATRISSI, KERRY A (DPT)
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:A
Last Name:PATRISSI
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 1:769 NORTHFIELD AVE
Mailing Address - Street 2:SUITE 132
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-1198
Mailing Address - Country:US
Mailing Address - Phone:973-669-3500
Mailing Address - Fax:973-669-3444
Practice Address - Street 1:11 EAGLE ROCK AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:EAST HANOVER
Practice Address - State:NJ
Practice Address - Zip Code:07936-3167
Practice Address - Country:US
Practice Address - Phone:973-887-9000
Practice Address - Fax:973-887-3816
Is Sole Proprietor?:No
Enumeration Date:2011-12-14
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01308500225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist