Provider Demographics
NPI:1760560163
Name:DIORISIO, ANTHONY (PT, DPT)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:
Last Name:DIORISIO
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 BECKETT RD STE 200
Mailing Address - Street 2:
Mailing Address - City:LOGAN TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08085-1732
Mailing Address - Country:US
Mailing Address - Phone:856-467-3421
Mailing Address - Fax:856-467-5731
Practice Address - Street 1:520 BECKETT RD STE 200
Practice Address - Street 2:
Practice Address - City:LOGAN TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08085-1732
Practice Address - Country:US
Practice Address - Phone:856-467-3421
Practice Address - Fax:856-467-5731
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2009-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA012253225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist