Provider Demographics
NPI:1184691412
Name:VITTESE, ANTHONY M III (MPT,CSCS)
Entity type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:M
Last Name:VITTESE
Suffix:III
Gender:M
Credentials:MPT,CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 5TH ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:ATCO
Mailing Address - State:NJ
Mailing Address - Zip Code:08004-1861
Mailing Address - Country:US
Mailing Address - Phone:856-768-3811
Mailing Address - Fax:
Practice Address - Street 1:501 5TH ST
Practice Address - Street 2:SUITE 1
Practice Address - City:ATCO
Practice Address - State:NJ
Practice Address - Zip Code:08004-1861
Practice Address - Country:US
Practice Address - Phone:856-768-3811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2008-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01118100225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist