Basic Information
| Provider Information | |||||||||
| NPI: | 1114941606 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SESALDO | ||||||||
| FirstName: | AIMEE | ||||||||
| MiddleName: | GO | ||||||||
| NamePrefix: | MISS | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14210 ROOSEVELT AVE | ||||||||
| Address2: | APT. 315 | ||||||||
| City: | FLUSHING | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113546046 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1633 BROADWAY | ||||||||
| Address2: | LOWER LEVEL 1C | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100196708 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2123159578 | ||||||||
| FaxNumber: | 2123159586 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/27/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 025446 | NY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.