Provider Demographics
NPI:1831113588
Name:GAROFALO, AIMEE NELSON (MSPT)
Entity Type:Individual
Prefix:
First Name:AIMEE
Middle Name:NELSON
Last Name:GAROFALO
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6101 ALCOA RD
Mailing Address - Street 2:APT. 421
Mailing Address - City:BENTON
Mailing Address - State:AR
Mailing Address - Zip Code:72015-6791
Mailing Address - Country:US
Mailing Address - Phone:561-252-1512
Mailing Address - Fax:
Practice Address - Street 1:1 MEDICAL PARK DR
Practice Address - Street 2:SALINE PEDIATRIC THERAPIES
Practice Address - City:BENTON
Practice Address - State:AR
Practice Address - Zip Code:72015-3353
Practice Address - Country:US
Practice Address - Phone:501-776-6925
Practice Address - Fax:501-776-6988
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL18918225100000X
AR2943225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist