Healthcare Provider Details

I. General information

NPI: 1285785790
Provider Name (Legal Business Name): THOMAS ANTHONY DEPAULIS PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2007
Last Update Date: 07/14/2020
Certification Date: 07/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

176 ROUTE 70
MEDFORD NJ
08055-8704
US

IV. Provider business mailing address

9 TUNBRIDGE WELLS CT
MEDFORD NJ
08055-3504
US

V. Phone/Fax

Practice location:
  • Phone: 856-608-7733
  • Fax: 856-608-7750
Mailing address:
  • Phone: 609-654-6943
  • Fax: 856-608-7750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberQA002790
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA00279000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: