Provider Demographics
NPI:1013104397
Name:SUCHCICKA, JOANNA (DPT)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:
Last Name:SUCHCICKA
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:PO BOX 4414
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08723-1614
Mailing Address - Country:US
Mailing Address - Phone:732-785-0040
Mailing Address - Fax:732-785-0265
Practice Address - Street 1:758 HIGHWAY 18
Practice Address - Street 2:SUITE 106
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-4910
Practice Address - Country:US
Practice Address - Phone:732-290-0090
Practice Address - Fax:732-254-2292
Is Sole Proprietor?:No
Enumeration Date:2007-10-01
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01207900225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist