MEDICARE: DR. DIANNA MARIE D AMORE MSPT, 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
1	2251P0200X	Pediatric Physical Therapist	028295-1	NY

General Provider Information

NPI Number	:	1689810566
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DIANNA MARIE D AMORE MSPT, DPT

Provider Business Mailing Address
First Line	:	15 GREENCROFT AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10308-3035
Country	:	US
Telephone Number	:	718-986-5037
Fax Number	:

Provider Business Practice Location Address
First Line	:	15 GREENCROFT AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10308-3035
Country	:	US
Telephone Number	:	718-986-5037
Fax Number	:

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

Provider Enumeration Date	:	12/26/2008
Last Update Date	:	09/29/2011

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