Provider Demographics
NPI:1013120757
Name:TEOPACO, JOEL CASTRO (RPT)
Entity Type:Individual
Prefix:MR
First Name:JOEL
Middle Name:CASTRO
Last Name:TEOPACO
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 E CONNECTICUT CONCOURSE
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08527-1427
Mailing Address - Country:US
Mailing Address - Phone:732-886-6605
Mailing Address - Fax:
Practice Address - Street 1:12 E CONNECTICUT CONCOURSE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:NJ
Practice Address - Zip Code:08527-1427
Practice Address - Country:US
Practice Address - Phone:732-886-6605
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01054100225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist