Provider Demographics
NPI:1497096192
Name:FUTRICK, PHILLIP (DPT)
Entity Type:Individual
Prefix:MR
First Name:PHILLIP
Middle Name:
Last Name:FUTRICK
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8500-1672
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-1672
Mailing Address - Country:US
Mailing Address - Phone:215-464-6600
Mailing Address - Fax:215-464-4378
Practice Address - Street 1:3110 GRANT AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19114-2542
Practice Address - Country:US
Practice Address - Phone:215-464-6600
Practice Address - Fax:215-612-4378
Is Sole Proprietor?:No
Enumeration Date:2013-03-06
Last Update Date:2015-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT0226182251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic