Provider Demographics
NPI:1477442093
Name:DILULLO, MICHAEL PASQUALE (PT, DPT)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:PASQUALE
Last Name:DILULLO
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 MEMORIAL PKWY APT 1B
Mailing Address - Street 2:
Mailing Address - City:PHILLIPSBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:08865-1264
Mailing Address - Country:US
Mailing Address - Phone:914-548-4084
Mailing Address - Fax:
Practice Address - Street 1:22 WALMART PLZ
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:NJ
Practice Address - Zip Code:08809-1263
Practice Address - Country:US
Practice Address - Phone:908-847-5210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-30
Last Update Date:2025-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA02345700225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist