Provider Demographics
NPI:1528282514
Name:DUNPHY, PHILLIP C (DPT)
Entity type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:C
Last Name:DUNPHY
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-2119
Mailing Address - Country:US
Mailing Address - Phone:732-275-3200
Mailing Address - Fax:732-275-3210
Practice Address - Street 1:300 BROAD ST
Practice Address - Street 2:
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-2119
Practice Address - Country:US
Practice Address - Phone:732-275-3200
Practice Address - Fax:732-275-3210
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00091300225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4377593OtherAETNA
NJ4377593OtherAETNA
NJ051861XCTMedicare UPIN