Basic Information
| Provider Information | |||||||||
| NPI: | 1740818335 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DE LUCA | ||||||||
| FirstName: | KATHARINE | ||||||||
| MiddleName: | LYNN | ||||||||
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| OtherLastName: | DE LUCA | ||||||||
| OtherFirstName: | KATELYNN | ||||||||
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| OtherCredential: | PT, DPT | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 20 COOK PLZ | ||||||||
| Address2: | |||||||||
| City: | MADISON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 079401951 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 20 COOK PLZ | ||||||||
| Address2: | |||||||||
| City: | MADISON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 079401951 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9732956460 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/30/2020 | ||||||||
| LastUpdateDate: | 03/30/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/30/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 045764-01 | NY | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | PT297776 | CA | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | 40QA01824300 | NJ | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.