Provider Demographics
NPI:1255426581
Name:YANNACCI, ANGELA (PT, MA, DPT)
Entity type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:
Last Name:YANNACCI
Suffix:
Gender:F
Credentials:PT, MA, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 MAXIM RD
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07731-8738
Mailing Address - Country:US
Mailing Address - Phone:732-751-1977
Mailing Address - Fax:
Practice Address - Street 1:524 WARDELL RD
Practice Address - Street 2:
Practice Address - City:TINTON FALLS
Practice Address - State:NJ
Practice Address - Zip Code:07753-7305
Practice Address - Country:US
Practice Address - Phone:732-922-9330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00605900225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist