MEDICARE: DR. RAYMOND FACCIOLO JR. DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	2251E1200X	Ergonomics Physical Therapist	DE
2	2251G0304X	Geriatric Physical Therapist	DE
3	2251X0800X	Orthopedic Physical Therapist	DE
4	225100000X	Physical Therapist	DE

General Provider Information

NPI Number	:	1619452745
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RAYMOND FACCIOLO JR. DPT

Provider Business Mailing Address
First Line	:	7 QUINCE CT
Second Line	:
City	:	WILMINGTON
State	:	DE
Zip	:	19808-4333
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1800 CONCORD PIKE
Second Line	:
City	:	WILMINGTON
State	:	DE
Zip	:	19897-0001
Country	:	US
Telephone Number	:	302-593-7760
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/25/2018
Last Update Date	:	09/25/2018

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