Provider Demographics
NPI:1457662801
Name:VISTOCCO, AMY JOCELYNANN (MPT)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:JOCELYNANN
Last Name:VISTOCCO
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 SMITH ST
Mailing Address - Street 2:
Mailing Address - City:STONY POINT
Mailing Address - State:NY
Mailing Address - Zip Code:10980-1617
Mailing Address - Country:US
Mailing Address - Phone:845-942-8592
Mailing Address - Fax:
Practice Address - Street 1:25 SMITH ST
Practice Address - Street 2:
Practice Address - City:STONY POINT
Practice Address - State:NY
Practice Address - Zip Code:10980-1617
Practice Address - Country:US
Practice Address - Phone:845-942-8592
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-30
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014170-12251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics