Provider Demographics
NPI:1639323322
Name:AMPO, MARGARITO ANTONIO URIBE (PT)
Entity Type:Individual
Prefix:
First Name:MARGARITO ANTONIO
Middle Name:URIBE
Last Name:AMPO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:169 ACADEMY AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10309-3215
Mailing Address - Country:US
Mailing Address - Phone:347-983-4047
Mailing Address - Fax:
Practice Address - Street 1:169 ACADEMY AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10309-3215
Practice Address - Country:US
Practice Address - Phone:347-983-4047
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-08
Last Update Date:2008-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0282752251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics