Provider Demographics
NPI:1205803715
Name:MACIBORSKI, PATRICIA (PT)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:MACIBORSKI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 GRIST MILL DR
Mailing Address - Street 2:
Mailing Address - City:BELLE MEAD
Mailing Address - State:NJ
Mailing Address - Zip Code:08502-5505
Mailing Address - Country:US
Mailing Address - Phone:908-874-4883
Mailing Address - Fax:
Practice Address - Street 1:71 GRIST MILL DR
Practice Address - Street 2:
Practice Address - City:BELLE MEAD
Practice Address - State:NJ
Practice Address - Zip Code:08502-5505
Practice Address - Country:US
Practice Address - Phone:908-874-4883
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2435225100000X
NJ40QA003081002251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Not Answered2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics