Provider Demographics
NPI:1942571484
Name:DIFILIPPO, BRIAN (PT,DPT,CSCS)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:DIFILIPPO
Suffix:
Gender:M
Credentials:PT,DPT,CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:628 BAMFORD RD
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08003-1402
Mailing Address - Country:US
Mailing Address - Phone:856-630-1329
Mailing Address - Fax:
Practice Address - Street 1:628 BAMFORD RD
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08003-1402
Practice Address - Country:US
Practice Address - Phone:856-630-1329
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-13
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ4OQA01413700225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist