Provider Demographics
NPI:1487796603
Name:PIMPINELLO, BRIAN JOSEPH (MPT)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:JOSEPH
Last Name:PIMPINELLO
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 ROUTE 73 STE 3
Mailing Address - Street 2:
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-9514
Mailing Address - Country:US
Mailing Address - Phone:856-312-3600
Mailing Address - Fax:949-577-4711
Practice Address - Street 1:148 ROUTE 73 STE 3
Practice Address - Street 2:
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-9514
Practice Address - Country:US
Practice Address - Phone:856-312-3600
Practice Address - Fax:949-577-4711
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2020-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJQA00854100225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist