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General NPI Number Information
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NPI Number | 1447396908
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Entity Type | Individual
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Provider Name | ALFONSO L AMATO P.T.
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Gender | Male
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Dates
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Enumeration Date | 01/30/2007
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Last Update Date | 12/31/2007
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Provider Practice Location Address
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Address Line | 11709 OLD BALLAS RD SUITE 205
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City | SAINT LOUIS
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State | MO
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Zip | 63141-7029
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Country | US
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Telephone | 314-991-0480
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Fax | 314-991-0487
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Provider Business Mailing Address
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Address Line | 132 AMBLESIDE LN
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City | SAINT LOUIS
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State | MO
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Zip | 63141-7437
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Country | US
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Telephone | 314-878-3970
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 12
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License Number State | MO
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