Provider Demographics
NPI:1154081032
Name:AFANTE, JOHN MICHAEL VINCENT RAGOT (DPT)
Entity Type:Individual
Prefix:DR
First Name:JOHN MICHAEL VINCENT
Middle Name:RAGOT
Last Name:AFANTE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:MIKE
Other - Middle Name:
Other - Last Name:AFANTE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPT
Mailing Address - Street 1:1311 MAMARONECK AVE STE 140
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10605-5224
Mailing Address - Country:US
Mailing Address - Phone:914-294-4050
Mailing Address - Fax:
Practice Address - Street 1:157 S CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:HARTSDALE
Practice Address - State:NY
Practice Address - Zip Code:10530-2314
Practice Address - Country:US
Practice Address - Phone:914-428-9698
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-20
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040057225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist