Basic Information
| Provider Information | |||||||||
| NPI: | 1669479259 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MONTECALVO | ||||||||
| FirstName: | KEITH | ||||||||
| MiddleName: | JOSEPH | ||||||||
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| Credential: | PT,DPT,OCS,MDT,SFMA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 224 STRAWBRIDGE DR STE 100 | ||||||||
| Address2: | |||||||||
| City: | MOORESTOWN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080574602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8566774000 | ||||||||
| FaxNumber: | 8562343014 | ||||||||
| Practice Location | |||||||||
| Address1: | 2123 HIGHWAY 35 | ||||||||
| Address2: | |||||||||
| City: | SEA GIRT | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 087501003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7324492001 | ||||||||
| FaxNumber: | 7324492238 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/28/2005 | ||||||||
| LastUpdateDate: | 06/30/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/30/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 40QA01087400 | NJ | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 2251X0800X | 40QA01087400 | NJ | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Orthopedic | 2251X0800X | QA10874 | NJ | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Orthopedic |
No ID Information.