Basic Information
| Provider Information | |||||||||
| NPI: | 1720337496 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ULLO | ||||||||
| FirstName: | FRANCO | ||||||||
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| Credential: | PTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 31 NEW DORP LN | ||||||||
| Address2: | |||||||||
| City: | STATEN ISLAND | ||||||||
| State: | NY | ||||||||
| PostalCode: | 103062351 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7183703500 | ||||||||
| FaxNumber: | 7189795236 | ||||||||
| Practice Location | |||||||||
| Address1: | 9920 4TH AVE | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112098333 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182389873 | ||||||||
| FaxNumber: | 7182389754 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/10/2012 | ||||||||
| LastUpdateDate: | 09/10/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | 006860 | NY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.