Provider Demographics
NPI:1174701395
Name:SCAFIDI, LILIANE BITTENCOURT (PT,DPT)
Entity type:Individual
Prefix:MRS
First Name:LILIANE
Middle Name:BITTENCOURT
Last Name:SCAFIDI
Suffix:
Gender:F
Credentials:PT,DPT
Other - Prefix:
Other - First Name:LILIANE
Other - Middle Name:SILVA
Other - Last Name:DEBITTENCOURT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:403 APRIL WAY
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07748-6510
Mailing Address - Country:US
Mailing Address - Phone:774-488-9513
Mailing Address - Fax:
Practice Address - Street 1:403 APRIL WAY
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NJ
Practice Address - Zip Code:07748-6510
Practice Address - Country:US
Practice Address - Phone:774-488-9513
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-11
Last Update Date:2014-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA18013225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ40QA01482300OtherNJ LICENSE