Provider Demographics
NPI:1295885176
Name:VISGIL, ANTHONY JOHN JR (PT)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:JOHN
Last Name:VISGIL
Suffix:JR
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 1:1423 TILTON RD
Mailing Address - Street 2:SUITE 10
Mailing Address - City:NORTHFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:08225-1857
Mailing Address - Country:US
Mailing Address - Phone:609-677-8778
Mailing Address - Fax:609-677-9229
Practice Address - Street 1:1423 TILTON RD
Practice Address - Street 2:SUITE 10
Practice Address - City:NORTHFIELD
Practice Address - State:NJ
Practice Address - Zip Code:08225-1857
Practice Address - Country:US
Practice Address - Phone:609-677-8778
Practice Address - Fax:609-677-9229
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00131700225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ193589Medicare ID - Type Unspecified