Provider Demographics
NPI:1386889731
Name:AMPONIN, MARYSOL JABIGUERO (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:
First Name:MARYSOL
Middle Name:JABIGUERO
Last Name:AMPONIN
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2139 WATSON AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10472-5401
Mailing Address - Country:US
Mailing Address - Phone:718-496-3834
Mailing Address - Fax:
Practice Address - Street 1:2139 WATSON AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10472-5401
Practice Address - Country:US
Practice Address - Phone:718-496-3834
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-12
Last Update Date:2008-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019427-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist