Provider Demographics
NPI:1174706451
Name:CANECCHIA, AUBREY (PT)
Entity type:Individual
Prefix:
First Name:AUBREY
Middle Name:
Last Name:CANECCHIA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 DULLES DR
Mailing Address - Street 2:
Mailing Address - City:DUMONT
Mailing Address - State:NJ
Mailing Address - Zip Code:07628-3630
Mailing Address - Country:US
Mailing Address - Phone:201-840-1980
Mailing Address - Fax:
Practice Address - Street 1:141 DULLES DR
Practice Address - Street 2:
Practice Address - City:DUMONT
Practice Address - State:NJ
Practice Address - Zip Code:07628-3630
Practice Address - Country:US
Practice Address - Phone:201-840-1980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-10
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA008592000225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist