Provider Demographics
NPI:1194036863
Name:DEVITO, MICHAEL D (PT)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:D
Last Name:DEVITO
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 1:35 ONEIDA AVE
Mailing Address - Street 2:
Mailing Address - City:DUMONT
Mailing Address - State:NJ
Mailing Address - Zip Code:07628-2109
Mailing Address - Country:US
Mailing Address - Phone:201-723-9986
Mailing Address - Fax:
Practice Address - Street 1:35 ONEIDA AVE
Practice Address - Street 2:
Practice Address - City:DUMONT
Practice Address - State:NJ
Practice Address - Zip Code:07628-2109
Practice Address - Country:US
Practice Address - Phone:201-723-9986
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-28
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00547400225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist