Basic Information
Provider Information | |||||||||
NPI: | 1457726226 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | VACCHIO | ||||||||
FirstName: | KAITLYNN | ||||||||
MiddleName: | MARIE | ||||||||
NamePrefix: | MRS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | PT, DPT, CSCS | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | TRZASKA | ||||||||
OtherFirstName: | KAIRLYNN | ||||||||
OtherMiddleName: | MARIE | ||||||||
OtherNamePrefix: | MS. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | PT, DPT, CSCS | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 224 STRAWBRIDGE DR STE 100 | ||||||||
Address2: |   | ||||||||
City: | MOORESTOWN | ||||||||
State: | NJ | ||||||||
PostalCode: | 080574602 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8566774000 | ||||||||
FaxNumber: | 8562343014 | ||||||||
Practice Location | |||||||||
Address1: | 1405A PENN AVE | ||||||||
Address2: |   | ||||||||
City: | WYOMISSING | ||||||||
State: | PA | ||||||||
PostalCode: | 196102133 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6103969278 | ||||||||
FaxNumber: | 6103969242 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 12/04/2015 | ||||||||
LastUpdateDate: | 05/12/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 05/12/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 2305212584 | VA | N |   | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |   | 225100000X | PT028999 | PA | Y |   | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |   | 225100000X | 039705-1 | NY | N |   | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |   |
No ID Information.