Provider Demographics
NPI:1275612988
Name:CIARDULLO, AUGUSTINE (PT)
Entity Type:Individual
Prefix:MR
First Name:AUGUSTINE
Middle Name:
Last Name:CIARDULLO
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 1:158 BISHOP DR
Mailing Address - Street 2:
Mailing Address - City:ASTON
Mailing Address - State:PA
Mailing Address - Zip Code:19014-1314
Mailing Address - Country:US
Mailing Address - Phone:610-459-5486
Mailing Address - Fax:215-334-4531
Practice Address - Street 1:2410 S BROAD ST
Practice Address - Street 2:
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19145-4418
Practice Address - Country:US
Practice Address - Phone:215-334-4400
Practice Address - Fax:215-334-4531
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT006311L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist