Provider Demographics
NPI:1578999082
Name:SOBOTKA PAGANO, VALERIE E (PT)
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:E
Last Name:SOBOTKA PAGANO
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 1:2841 THOUSAND ACRES RD
Mailing Address - Street 2:
Mailing Address - City:DELANSON
Mailing Address - State:NY
Mailing Address - Zip Code:12053-1917
Mailing Address - Country:US
Mailing Address - Phone:518-875-6724
Mailing Address - Fax:
Practice Address - Street 1:40 HENRIETTA BLVD
Practice Address - Street 2:
Practice Address - City:AMSTERDAM
Practice Address - State:NY
Practice Address - Zip Code:12010-1111
Practice Address - Country:US
Practice Address - Phone:518-843-3003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-17
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020954225100000X
174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist