Provider Demographics
NPI:1528006442
Name:VENDETTI, ANTHONY (PT)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:VENDETTI
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 1:32 BALLINGER WAY
Mailing Address - Street 2:
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-5232
Mailing Address - Country:US
Mailing Address - Phone:609-560-8101
Mailing Address - Fax:
Practice Address - Street 1:7204 N PARK DR
Practice Address - Street 2:ROUTE 130
Practice Address - City:PENNSAUKEN
Practice Address - State:NJ
Practice Address - Zip Code:08109-4210
Practice Address - Country:US
Practice Address - Phone:856-663-7690
Practice Address - Fax:856-663-9269
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJQAO3817225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist