MEDICARE: MR. DANIELE B D'AMBROSIO MPT

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
1	225100000X	Physical Therapist	17717	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114020559
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DANIELE B D'AMBROSIO MPT

Provider Business Mailing Address
First Line	:	966 NAUTILUS ISLE
Second Line	:
City	:	DANIA BEACH
State	:	FL
Zip	:	33004-2356
Country	:	US
Telephone Number	:	954-476-5928
Fax Number	:	954-530-7240

Provider Business Practice Location Address
First Line	:	966 NAUTILUS ISLE
Second Line	:
City	:	DANIA BEACH
State	:	FL
Zip	:	33004-2356
Country	:	US
Telephone Number	:	954-476-5928
Fax Number	:	954-530-7240

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/07/2006
Last Update Date	:	09/19/2011

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