Healthcare Provider Details

I. General information

NPI: 1700846748
Provider Name (Legal Business Name): DAVID BRYAN HUTTINGER PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 08/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 N MAPLE AVE
MARLTON NJ
08053-9400
US

IV. Provider business mailing address

230 N MAPLE AVE STE B10
MARLTON NJ
08053-9423
US

V. Phone/Fax

Practice location:
  • Phone: 609-320-1471
  • Fax:
Mailing address:
  • Phone: 856-396-2500
  • Fax: 856-396-2525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA00485800
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT009524L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: