Provider Demographics
NPI:1801265491
Name:VACCARO, ATHENA (MS, PT)
Entity type:Individual
Prefix:MRS
First Name:ATHENA
Middle Name:
Last Name:VACCARO
Suffix:
Gender:F
Credentials:MS, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:431 CARPENTER AVE
Mailing Address - Street 2:
Mailing Address - City:SEA CLIFF
Mailing Address - State:NY
Mailing Address - Zip Code:11579-2102
Mailing Address - Country:US
Mailing Address - Phone:646-872-3287
Mailing Address - Fax:
Practice Address - Street 1:431 CARPENTER AVE
Practice Address - Street 2:
Practice Address - City:SEA CLIFF
Practice Address - State:NY
Practice Address - Zip Code:11579-2102
Practice Address - Country:US
Practice Address - Phone:646-872-3287
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-24
Last Update Date:2015-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012818-12251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics