Provider Demographics
NPI:1649580986
Name:CALVINO, AUDREY (DPT)
Entity Type:Individual
Prefix:DR
First Name:AUDREY
Middle Name:
Last Name:CALVINO
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:336 FAIRVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:NY
Mailing Address - Zip Code:12534-1203
Mailing Address - Country:US
Mailing Address - Phone:518-828-7101
Mailing Address - Fax:518-828-7102
Practice Address - Street 1:1220 NEW SCOTLAND RD
Practice Address - Street 2:SUITE 103
Practice Address - City:SLINGERLANDS
Practice Address - State:NY
Practice Address - Zip Code:12159-9386
Practice Address - Country:US
Practice Address - Phone:518-439-5006
Practice Address - Fax:518-641-0375
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-20
Last Update Date:2015-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020228208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation