Provider Demographics
NPI:1417828617
Name:PONTECORVO, ROSE (DPT, PT)
Entity type:Individual
Prefix:
First Name:ROSE
Middle Name:
Last Name:PONTECORVO
Suffix:
Gender:F
Credentials:DPT, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 LOCKTOWN SERGEANTSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08559-1117
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1000 NORTHSIDE DR NW STE 1500
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30318-5479
Practice Address - Country:US
Practice Address - Phone:404-355-0743
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-12
Last Update Date:2025-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist