Provider Demographics
NPI:1801036371
Name:CERRUTI, DOMENIC O ANTHONY (LPTA)
Entity Type:Individual
Prefix:MR
First Name:DOMENIC O
Middle Name:ANTHONY
Last Name:CERRUTI
Suffix:
Gender:M
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8123 MARTINDALE ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19136-1820
Mailing Address - Country:US
Mailing Address - Phone:215-676-4070
Mailing Address - Fax:
Practice Address - Street 1:2869 HOLME AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19152-2118
Practice Address - Country:US
Practice Address - Phone:215-676-4070
Practice Address - Fax:215-676-4071
Is Sole Proprietor?:No
Enumeration Date:2009-02-24
Last Update Date:2009-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE1001931225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant