Individual
MR. JOSEPH DATTILO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT, C.PED
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
Update your record
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