Provider Demographics
NPI:1013707850
Name:DIGEROLAMO, VICKI (LMT, MMP)
Entity type:Individual
Prefix:
First Name:VICKI
Middle Name:
Last Name:DIGEROLAMO
Suffix:
Gender:
Credentials:LMT, MMP
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:
Other - Last Name:DIGEROLAMO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:39 CREEKSIDE WAY
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08016-1006
Mailing Address - Country:US
Mailing Address - Phone:609-678-5776
Mailing Address - Fax:
Practice Address - Street 1:23659 COLUMBUS RD STE 2D
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:NJ
Practice Address - Zip Code:08022-1980
Practice Address - Country:US
Practice Address - Phone:609-678-5776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-06
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ18KT01345800225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist