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General NPI Number Information
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NPI Number | 1114316031
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Entity Type | Individual
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Provider Name | JOHN CARMEN IANNELLI JR. PT, DPT
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Gender | Male
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Dates
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Enumeration Date | 01/15/2015
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Last Update Date | 11/30/2023
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Provider Practice Location Address
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Address Line | 1165 N TUCKAHOE RD
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City | WILLIAMSTOWN
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State | NJ
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Zip | 08094-3459
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Country | US
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Telephone | 856-237-7467
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Fax | 856-716-6525
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Provider Business Mailing Address
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Address Line | 1165 N TUCKAHOE RD
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City | WILLIAMSTOWN
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State | NJ
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Zip | 08094-3459
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Country | US
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Telephone | 856-237-7467
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Fax | 856-716-6525
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | J1-0003262
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License Number State | DE
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 40QA01800800
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License Number State | NJ
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