Provider Demographics
NPI:1548294721
Name:VITOLO, ANNIKA
Entity type:Individual
Prefix:
First Name:ANNIKA
Middle Name:
Last Name:VITOLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANNIKA
Other - Middle Name:
Other - Last Name:KAYE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSPT
Mailing Address - Street 1:21635 BIDEN AVE UNIT 207
Mailing Address - Street 2:BEEBE HEALTHCARE HEALTHYBACK
Mailing Address - City:GEORGETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19947-4576
Mailing Address - Country:US
Mailing Address - Phone:302-217-3000
Mailing Address - Fax:302-217-3005
Practice Address - Street 1:21635 BIDEN AVE UNIT 207
Practice Address - Street 2:BEEBE HEALTHCARE HEALTHYBACK
Practice Address - City:GEORGETOWN
Practice Address - State:DE
Practice Address - Zip Code:19947-4576
Practice Address - Country:US
Practice Address - Phone:302-217-3000
Practice Address - Fax:302-217-3005
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2015-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00636700225100000X
DEJ10003207225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist