Provider Demographics
NPI:1184685414
Name:EGNOTO, ANTHONY (DPT)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:EGNOTO
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4886 W TAFT RD
Mailing Address - Street 2:
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13088-4810
Mailing Address - Country:US
Mailing Address - Phone:315-457-5867
Mailing Address - Fax:315-457-6306
Practice Address - Street 1:4886 W TAFT RD
Practice Address - Street 2:
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13088-4810
Practice Address - Country:US
Practice Address - Phone:315-457-5867
Practice Address - Fax:315-457-6306
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027488225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYRA8501Medicare ID - Type UnspecifiedMEDICARE NUMBER