Provider Demographics
NPI:1659569747
Name:ADVIENTO, AMPARO (PT)
Entity Type:Individual
Prefix:
First Name:AMPARO
Middle Name:
Last Name:ADVIENTO
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 1:11940 UNION TPKE
Mailing Address - Street 2:#5R
Mailing Address - City:KEW GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11415-1161
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:104 DELANCEY ST
Practice Address - Street 2:2FL
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10002-3202
Practice Address - Country:US
Practice Address - Phone:212-533-5090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-15
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022827225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist