Healthcare Provider Details

I. General information

NPI: 1063781219
Provider Name (Legal Business Name): ANDREA SILVANA ESCOS PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2011
Last Update Date: 12/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

173 MARTIN STREET
ROCHESTER NY
14605
US

IV. Provider business mailing address

62 AMSTERDAM RD
ROCHESTER NY
14610-1007
US

V. Phone/Fax

Practice location:
  • Phone: 585-738-1974
  • Fax:
Mailing address:
  • Phone: 585-738-1974
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number012187-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: