Provider Demographics
NPI:1174612204
Name:TE, MARIA IMELDA AMIGLEO (PT)
Entity type:Individual
Prefix:
First Name:MARIA IMELDA
Middle Name:AMIGLEO
Last Name:TE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4041 VIA MARISOL AVE.
Mailing Address - Street 2:UNIT 305
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90042
Mailing Address - Country:US
Mailing Address - Phone:323-683-0445
Mailing Address - Fax:
Practice Address - Street 1:18391 COLIMA RD
Practice Address - Street 2:UNIT 205
Practice Address - City:ROWLAND HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:91748-2730
Practice Address - Country:US
Practice Address - Phone:626-964-3326
Practice Address - Fax:626-964-3346
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT33112225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT33112OtherPHYSICAL THERAPY LICENSE