Provider Demographics
NPI:1114941606
Name:SESALDO, AIMEE GO (PT)
Entity Type:Individual
Prefix:MISS
First Name:AIMEE
Middle Name:GO
Last Name:SESALDO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:14210 ROOSEVELT AVE
Mailing Address - Street 2:APT. 315
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-6046
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1633 BROADWAY
Practice Address - Street 2:LOWER LEVEL 1C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-6708
Practice Address - Country:US
Practice Address - Phone:212-315-9578
Practice Address - Fax:212-315-9586
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY025446225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ20V01Medicare ID - Type Unspecified