Provider Demographics
NPI:1508801788
Name:FILIPPONE, CHARLES TRAVIS (PT)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:TRAVIS
Last Name:FILIPPONE
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 1:25 ALLENHURST AVE
Mailing Address - Street 2:
Mailing Address - City:OCEANPORT
Mailing Address - State:NJ
Mailing Address - Zip Code:07757-1337
Mailing Address - Country:US
Mailing Address - Phone:732-888-1310
Mailing Address - Fax:
Practice Address - Street 1:300 W SYLVANIA AVE
Practice Address - Street 2:SUITE 9
Practice Address - City:NEPTUNE
Practice Address - State:NJ
Practice Address - Zip Code:07753-6017
Practice Address - Country:US
Practice Address - Phone:732-869-1818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00153500225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist