Provider Demographics
NPI:1831675024
Name:PRESTO, LYDIA JOY (PT, DPT)
Entity type:Individual
Prefix:
First Name:LYDIA
Middle Name:JOY
Last Name:PRESTO
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:LYDIA
Other - Middle Name:JOY
Other - Last Name:ROGERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:298 CLAREMONT AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-2812
Mailing Address - Country:US
Mailing Address - Phone:609-332-6682
Mailing Address - Fax:
Practice Address - Street 1:784 FRANKLIN AVE STE 230
Practice Address - Street 2:
Practice Address - City:FRANKLIN LAKES
Practice Address - State:NJ
Practice Address - Zip Code:07417-1306
Practice Address - Country:US
Practice Address - Phone:201-903-1554
Practice Address - Fax:201-891-0014
Is Sole Proprietor?:No
Enumeration Date:2018-07-11
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01742400225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist