Provider Demographics
NPI:1083615967
Name:ESPOSITO, VINCENT P (PT)
Entity Type:Individual
Prefix:
First Name:VINCENT
Middle Name:P
Last Name:ESPOSITO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1809 OREGON AVE
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19145
Mailing Address - Country:US
Mailing Address - Phone:215-467-1800
Mailing Address - Fax:215-467-8120
Practice Address - Street 1:1809 OREGON AVE
Practice Address - Street 2:3RD FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19145
Practice Address - Country:US
Practice Address - Phone:215-467-1800
Practice Address - Fax:215-467-8120
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2010-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT003173L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA414748Medicare ID - Type Unspecified