MEDICARE: MARIA VILLANUEVA AMPARO P.T.

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	QA007998	NJ
2	225100000X	Physical Therapist	018672	NY

General Provider Information

NPI Number	:	1922193721
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIA VILLANUEVA AMPARO P.T.

Provider Business Mailing Address
First Line	:	131 PALISADE AVE
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07306-1101
Country	:	US
Telephone Number	:	201-761-9490
Fax Number	:	201-792-5343

Provider Business Practice Location Address
First Line	:	131 PALISADE AVE
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07306-1101
Country	:	US
Telephone Number	:	201-761-9490
Fax Number	:	201-792-5343

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

Provider Enumeration Date	:	10/04/2006
Last Update Date	:	07/08/2007

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