Provider Demographics
NPI:1194710756
Name:DATTILO, JOSEPH (PT, CPED)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:
Last Name:DATTILO
Suffix:
Gender:M
Credentials:PT, CPED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 COMMERCE WAY
Mailing Address - Street 2:STE. 120
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-8200
Mailing Address - Country:US
Mailing Address - Phone:603-427-8066
Mailing Address - Fax:603-501-0495
Practice Address - Street 1:64 PORTSMOUTH AVE
Practice Address - Street 2:SUITE 5
Practice Address - City:STRATHAM
Practice Address - State:NH
Practice Address - Zip Code:03885-2523
Practice Address - Country:US
Practice Address - Phone:603-772-8222
Practice Address - Fax:603-772-6738
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1866225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3820128OtherAETNA
NH4353867OtherCIGNA
NH08Y008079NH01OtherBLUE CROSS BLUE SHIELD
NH201859513OtherTAX ID
NH4353867OtherCIGNA