Provider Demographics
NPI:1578865424
Name:AMIGO, ALIUSKA I (MA)
Entity Type:Individual
Prefix:MRS
First Name:ALIUSKA
Middle Name:
Last Name:AMIGO
Suffix:I
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1105 NE 10 LN
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33909
Mailing Address - Country:US
Mailing Address - Phone:305-985-8395
Mailing Address - Fax:305-819-2195
Practice Address - Street 1:1105 NE 10 LN
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33909
Practice Address - Country:US
Practice Address - Phone:305-819-2194
Practice Address - Fax:305-819-2195
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-29
Last Update Date:2023-09-29
Deactivation Date:2023-09-13
Deactivation Code:
Reactivation Date:2023-09-29
Provider Licenses
StateLicense IDTaxonomies
FLPTA26143225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant