Provider Demographics
NPI:1235217407
Name:D'APPOLLONIO, ELIO ALDO (PT)
Entity Type:Individual
Prefix:MR
First Name:ELIO
Middle Name:ALDO
Last Name:D'APPOLLONIO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:MR
Other - First Name:AL
Other - Middle Name:ALDO
Other - Last Name:D'APPOLLONIO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:9836 N 22ND PL
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-3624
Mailing Address - Country:US
Mailing Address - Phone:602-493-5139
Mailing Address - Fax:
Practice Address - Street 1:2423 W DUNLAP AVE
Practice Address - Street 2:SUITE 170
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021-2830
Practice Address - Country:US
Practice Address - Phone:602-870-1414
Practice Address - Fax:602-870-4141
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ831225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ831OtherLICENSE
AZ210881Medicaid
AZ831OtherLICENSE
R10164Medicare UPIN