Provider Demographics
NPI:1497797989
Name:AMBROGI, JOANNE (PT)
Entity Type:Individual
Prefix:
First Name:JOANNE
Middle Name:
Last Name:AMBROGI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 COVENTRY DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19810-3919
Mailing Address - Country:US
Mailing Address - Phone:610-368-1006
Mailing Address - Fax:
Practice Address - Street 1:2000 PENNSYLVANIA AVE
Practice Address - Street 2:SUITE 208
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19806-2450
Practice Address - Country:US
Practice Address - Phone:610-368-1006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-11
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ1001634225100000X
PAPT015364225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000037826Medicaid
1440690OtherPABS
61989602OtherCAREFIRST/NCA
11795622OtherCAQH
2181847000OtherAMERIHEALTH
5070-0023OtherCAREFIRST/FEDERAL
2107808OtherMAMSI
DEG02378A15Medicare PIN
2181847000OtherAMERIHEALTH
1440690OtherPABS
P80054Medicare UPIN
DE011942F68Medicare ID - Type Unspecified