Provider Demographics
NPI:1164645917
Name:GAYTANO, MARICHU MARCELO (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:
First Name:MARICHU
Middle Name:MARCELO
Last Name:GAYTANO
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 EISENHOWER DRIVE
Mailing Address - Street 2:
Mailing Address - City:SAYREVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08872
Mailing Address - Country:US
Mailing Address - Phone:732-651-1813
Mailing Address - Fax:
Practice Address - Street 1:625
Practice Address - Street 2:ROUTE 34
Practice Address - City:MATAWAN
Practice Address - State:NJ
Practice Address - Zip Code:07747
Practice Address - Country:US
Practice Address - Phone:732-888-2453
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJPTQA00718100225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist