Healthcare Provider Details

I. General information

NPI: 1245644939
Provider Name (Legal Business Name): GLORIA CILLUFFO PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2014
Last Update Date: 06/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 CREAMERY WAY SUITE 300
EXTON PA
19341-2551
US

IV. Provider business mailing address

343 OLD BAILEY LN
WEST CHESTER PA
19382-8491
US

V. Phone/Fax

Practice location:
  • Phone: 484-875-0200
  • Fax:
Mailing address:
  • Phone: 610-304-2454
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT019259
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: