Provider Demographics
NPI:1588136980
Name:MOYA, AMANDA (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:
Last Name:MOYA
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:
Other - Last Name:PEREGRINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:113 HILLTOP ACRES
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10704-2848
Mailing Address - Country:US
Mailing Address - Phone:203-942-9054
Mailing Address - Fax:
Practice Address - Street 1:4 LORRAINE AVE
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10553-1222
Practice Address - Country:US
Practice Address - Phone:914-663-7070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-23
Last Update Date:2018-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY043861225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist