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NPI Code Detail

MEDICARE: MRS. MICHELE MODUGNO PT DPT

MEDICARE: MRS. MICHELE MODUGNO PT DPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist036325NY

General Provider Information

NPI Number : 1790175115
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MICHELE MODUGNO PT DPT
Provider Business Mailing Address
First Line : 104 CARTWHEEL CT
Second Line : APT. 18
City : WASHINGTONVILLE
State : NY
Zip : 10992-2211
Country : US
Telephone Number : 321-217-2780
Fax Number :
Provider Business Practice Location Address
First Line : 2817 ALBANY POST RD
Second Line :
City : MONTGOMERY
State : NY
Zip : 12549-2132
Country : US
Telephone Number : 845-457-3155
Fax Number : 845-457-4899
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/24/2015
Last Update Date : 01/24/2015

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