Provider Demographics
NPI:1548634025
Name:VILLACORTA, JANETTE
Entity type:Individual
Prefix:
First Name:JANETTE
Middle Name:
Last Name:VILLACORTA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81 MARKET ST APT 1
Mailing Address - Street 2:
Mailing Address - City:GARFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07026-3722
Mailing Address - Country:US
Mailing Address - Phone:201-898-3415
Mailing Address - Fax:
Practice Address - Street 1:935 ALLWOOD RD
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07012-1988
Practice Address - Country:US
Practice Address - Phone:973-928-3590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-19
Last Update Date:2017-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QB00324900225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant