Provider Demographics
NPI:1194879684
Name:MCGORRY, AMY M (PT)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:M
Last Name:MCGORRY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:330 W 58TH ST STE 203
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-1822
Mailing Address - Country:US
Mailing Address - Phone:212-582-7020
Mailing Address - Fax:212-582-7021
Practice Address - Street 1:12 E 46TH ST FL 8
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-2418
Practice Address - Country:US
Practice Address - Phone:212-499-0876
Practice Address - Fax:212-953-1353
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
012234-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q08L51Medicare PIN