Healthcare Provider Details

I. General information

NPI: 1568835601
Provider Name (Legal Business Name): DIGIULIO PHYSICAL THERAPY & WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2015
Last Update Date: 11/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7508 LORETTO AVE
PHILA PA
19111-3833
US

IV. Provider business mailing address

7508 LORETTO AVE
PHILA PA
19111-3833
US

V. Phone/Fax

Practice location:
  • Phone: 267-399-3987
  • Fax:
Mailing address:
  • Phone: 267-399-3987
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberDAPT003270
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number022980
License Number StatePA

VII. Legacy identifiers

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

VIII. Authorized Official

Name: KEVIN DIGIULIO
Title or Position: PHYSICAL THERAPIST
Credential: P.T.
Phone: 267-408-0398