Provider Demographics
NPI:1801940481
Name:GORCZYCA, KELLY EILEEN (MS, PT)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:EILEEN
Last Name:GORCZYCA
Suffix:
Gender:F
Credentials:MS, PT
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Mailing Address - Street 1:PO BOX 417
Mailing Address - Street 2:
Mailing Address - City:ALLAMUCHY
Mailing Address - State:NJ
Mailing Address - Zip Code:07820-0417
Mailing Address - Country:US
Mailing Address - Phone:908-684-4700
Mailing Address - Fax:908-684-4744
Practice Address - Street 1:101 BILBY RD
Practice Address - Street 2:HACKETTSTOWN COMMERCE PARK, BUILDING 2
Practice Address - City:HACKETTSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07840-1753
Practice Address - Country:US
Practice Address - Phone:908-684-4700
Practice Address - Fax:908-684-4744
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
225100000X
NJ40QA007623002251S0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Not Answered2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ40QA00762300OtherLICENSE
NJ40QA00762300OtherLICENSE