Provider Demographics
NPI:1114020559
Name:D'AMBROSIO, DANIELE B (MPT)
Entity Type:Individual
Prefix:MR
First Name:DANIELE
Middle Name:B
Last Name:D'AMBROSIO
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:966 NAUTILUS ISLE
Mailing Address - Street 2:
Mailing Address - City:DANIA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33004-2356
Mailing Address - Country:US
Mailing Address - Phone:954-476-5928
Mailing Address - Fax:954-530-7240
Practice Address - Street 1:966 NAUTILUS ISLE
Practice Address - Street 2:
Practice Address - City:DANIA BEACH
Practice Address - State:FL
Practice Address - Zip Code:33004-2356
Practice Address - Country:US
Practice Address - Phone:954-476-5928
Practice Address - Fax:954-530-7240
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-07
Last Update Date:2011-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL17717225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL887850100Medicaid
FL887850100Medicaid