Active NPI
Nicole Ditullio
- Physical Therapy Assistant
- Philadelphia, PA
National Provider Identifier
1790459691
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- TE012823
- Practice address
- 9896 Bustleton Ave
Philadelphia, PA 19115-5202 - Phone
- (215) 934-3000
- NPI assigned
- Aug 4, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | TE012823 | PA | Primary |
Addresses
Primary practice location
9896 Bustleton Ave
Philadelphia, PA 19115-5202
Mailing address
814 Mountain St
Philadelphia, PA 19148-1207
Phone (267) 838-8097
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| TE012823 | PA | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1628035200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1628035200000",
"number": "1790459691",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "814 MOUNTAIN ST",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191481207",
"telephone_number": "267-838-8097"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9896 BUSTLETON AVE",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191155202",
"telephone_number": "215-934-3000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DITULLIO",
"first_name": "NICOLE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-08-04",
"last_updated": "2021-08-04",
"certification_date": "2021-08-04",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "PA",
"license": "TE012823",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Philadelphia, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.