Provider Demographics
NPI:1023565538
Name:PECORARO, MATTHEW DAVID (PT, DPT)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:DAVID
Last Name:PECORARO
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 OCEANPORT AVE
Mailing Address - Street 2:BUILDING 2
Mailing Address - City:LITTLE SILVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07739-1211
Mailing Address - Country:US
Mailing Address - Phone:732-758-0002
Mailing Address - Fax:
Practice Address - Street 1:116 OCEANPORT AVE
Practice Address - Street 2:BUILDING 2
Practice Address - City:LITTLE SILVER
Practice Address - State:NJ
Practice Address - Zip Code:07739-1211
Practice Address - Country:US
Practice Address - Phone:732-758-0002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01689700225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist