Provider Demographics
NPI:1679345318
Name:TRIFIRO, AMY NICOLE (PTA)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:NICOLE
Last Name:TRIFIRO
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:NICOLE
Other - Last Name:FERENTINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:8 MONTE CARLO DR
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-1620
Mailing Address - Country:US
Mailing Address - Phone:732-604-4488
Mailing Address - Fax:
Practice Address - Street 1:530 LAKEHURST RD STE 202
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-8063
Practice Address - Country:US
Practice Address - Phone:732-349-1201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-26
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QB00340200225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant