Provider Demographics
NPI:1518035609
Name:AMODIO, JOHN VINCENT (PT)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:VINCENT
Last Name:AMODIO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:25 MOUNTAIVIEW BLVD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:BASKING RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07920
Mailing Address - Country:US
Mailing Address - Phone:908-758-1006
Mailing Address - Fax:908-360-0511
Practice Address - Street 1:665 MARTINVILLE ROAD
Practice Address - Street 2:SUITE 219A
Practice Address - City:BASKING
Practice Address - State:NJ
Practice Address - Zip Code:07920
Practice Address - Country:US
Practice Address - Phone:908-758-1006
Practice Address - Fax:908-360-0511
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2017-10-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ40QA01313200225100000X
NY021392225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ40QA01313200OtherNJ LICENSE