Justin D Ditheodore, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

40QA01339000 Issued in NJ

Practice address

298 S Delsea Dr
Vineland, NJ 08360-4568

Phone

(856) 690-1616

Fax

(856) 690-1089

NPI assigned

Mar 10, 2010

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NJ

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2009

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Premier Orthopaedic and Sports Medicine Assoc of Southern NJ LLCGroup PAC ID 1557388436, 36 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Premier Orthopaedic and Sports Medicine Assoc of Southern NJ LLC

  • Orthopaedic Surgery Physician
  • Vineland, NJ
  • NPI 1396812574
  Medicare reassignment Care Compare group NPD
• Advanced Orthopaedic Centers PA

  • Orthopaedic Surgery Physician
  • Woodbury, NJ
  • NPI 1275574667

  Physical Therapist

  Medicare reassignment NPD
• Premier Orthopaedic and Sports Medicine Assoc of Southern NJ LLC

  • Orthopaedic Surgery Physician
  • Mullica Hill, NJ
  • NPI 1457092611
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1268179200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1588118400000",
    "number": "1073836656",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "352 S DELSEA DR STE C",
            "city": "VINELAND",
            "state": "NJ",
            "postal_code": "083605306",
            "telephone_number": "856-690-1616",
            "fax_number": "856-690-1089"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "298 S DELSEA DR",
            "city": "VINELAND",
            "state": "NJ",
            "postal_code": "083604568",
            "telephone_number": "856-690-1616",
            "fax_number": "856-690-1089"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DITHEODORE",
        "first_name": "JUSTIN",
        "middle_name": "D",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-03-10",
        "last_updated": "2020-04-29",
        "certification_date": "2020-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NJ",
            "license": "40QA01339000",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jennifer Dillon
• Jennifer Dimapilis, PT
• Susan Lynn Diniz, RDN
• Nicole Dipierro
• Vincent Disabella, DO
• Richard Charles Diverniero, MD
• Ric Jayson Dizon, PT
• Don S. Cooper DC PC
• Anne Marie Donahue, LCSW
• Brenda Marcus Dorais, MS, CCC-SLP/A

• Physical Therapist in Vineland, NJ
• Providers in Vineland, NJ by specialty
• Physical Therapist in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.