Healthcare Provider Details

I. General information

NPI: 1669885877
Provider Name (Legal Business Name): JOEL SIVILLO DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2014
Last Update Date: 06/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

698 MORRISON RD
COLUMBUS OH
43213-4419
US

IV. Provider business mailing address

698 MORRISON RD
COLUMBUS OH
43213-4419
US

V. Phone/Fax

Practice location:
  • Phone: 614-868-1115
  • Fax:
Mailing address:
  • Phone: 614-868-1115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT.014785
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: