Provider Demographics
NPI:1134473127
Name:LAURETA, AMORSOLO CENON JR (PT)
Entity Type:Individual
Prefix:MR
First Name:AMORSOLO
Middle Name:CENON
Last Name:LAURETA
Suffix:JR
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6440 58TH RD
Mailing Address - Street 2:
Mailing Address - City:MASPETH
Mailing Address - State:NY
Mailing Address - Zip Code:11378-2806
Mailing Address - Country:US
Mailing Address - Phone:718-316-7072
Mailing Address - Fax:
Practice Address - Street 1:6440 58TH RD
Practice Address - Street 2:
Practice Address - City:MASPETH
Practice Address - State:NY
Practice Address - Zip Code:11378-2806
Practice Address - Country:US
Practice Address - Phone:718-316-7072
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-30
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019985-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist