Basic Information
Provider Information
NPI: 1821341835
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: APPALUCCI
FirstName: KELLY
MiddleName: A
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: STINSON
OtherFirstName: KELLY
OtherMiddleName: A
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType: 1
Mailing Information
Address1: 7 CARNEGIE PLAZA
Address2:  
City: CHERRY HILL
State: NJ
PostalCode: 08003
CountryCode: US
TelephoneNumber: 8774073422
FaxNumber: 8774074329
Practice Location
Address1: 7 CARNEGIE PLAZA
Address2:  
City: CHERRY HILL
State: NJ
PostalCode: 08003
CountryCode: US
TelephoneNumber: 8774073422
FaxNumber: 8774074329
Other Information
ProviderEnumerationDate: 10/16/2012
LastUpdateDate: 06/26/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000X40QA01362600NJY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

No ID Information.


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