Individual
MR. JOSEPH DATTILO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT, C.PED
Contact information
Practice address
64 PORTSMOUTH AVE, SUITE 5, STRATHAM, NH 03885-2523
(603) 772-8222
(603) 772-6738
Mailing address
210 COMMERCE WAY, STE. 120, PORTSMOUTH, NH 03801-8200
(603) 427-8066
(603) 501-0495
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1866
NH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
08Y008079NH01
BLUE CROSS BLUE SHIELD
NH
01
—
201859513
TAX ID
NH
01
—
3820128
AETNA
NH
01
—
4353867
CIGNA
NH
Enumeration date
09/20/2005
Last updated
05/03/2017
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