Provider Demographics
NPI:1497109623
Name:JOSAFAT, AIMEE (PT)
Entity Type:Individual
Prefix:
First Name:AIMEE
Middle Name:
Last Name:JOSAFAT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:AIMEE
Other - Middle Name:PAPA
Other - Last Name:NEPOMUCENO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:30660 MILKY WAY DR # X186
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592-3296
Mailing Address - Country:US
Mailing Address - Phone:951-436-8150
Mailing Address - Fax:
Practice Address - Street 1:30660 MILKY WAY DR # X186
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92592-3296
Practice Address - Country:US
Practice Address - Phone:951-436-8150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-13
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT29336225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist