Provider Demographics
NPI:1811231418
Name:TALERICO, IRYNA V (DPT)
Entity type:Individual
Prefix:
First Name:IRYNA
Middle Name:V
Last Name:TALERICO
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 WOODBURY TURNERSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:BLACKWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08012-2960
Mailing Address - Country:US
Mailing Address - Phone:856-374-6429
Mailing Address - Fax:
Practice Address - Street 1:425 WOODBURY TURNERSVILLE RD
Practice Address - Street 2:
Practice Address - City:BLACKWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08012-2960
Practice Address - Country:US
Practice Address - Phone:856-374-6429
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-20
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01374400225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist