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NPI 1922168111

NPI 1922168111 : BARBARA J AMELIO PTA : GOSHEN, NY

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General NPI Number Information
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    NPI Number           |    1922168111
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    Entity Type          |    Individual 
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    Provider Name        |    BARBARA J AMELIO PTA
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    Gender               |    Female 
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Dates
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    Enumeration Date     |    12/11/2006
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    Last Update Date     |    07/08/2007
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Provider Practice Location Address
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    Address Line         |    2 FLETCHER ST 
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    City                 |    GOSHEN
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    State                |    NY
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    Zip                  |    10924-1402
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    Country              |    US
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    Telephone            |    845-294-8806
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    Fax                  |    845-294-8650
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Provider Business Mailing Address
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    Address Line         |    389 VAN BURENVILLE RD 
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    City                 |    MIDDLETOWN
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    State                |    NY
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    Zip                  |    10940-2229
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    Country              |    US
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    Telephone            |    845-386-2499
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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        |    225200000X
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    Taxonomy Name        |    Physical Therapy Assistant
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    License Number       |    004669-1
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    License Number State |    NY
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