MEDICARE: MISS EMILY KATRINA LACEA-LAYCO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	030671	NY

General Provider Information

NPI Number	:	1396075263
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS EMILY KATRINA LACEA-LAYCO

Provider Business Mailing Address
First Line	:	3112 MILES AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10465-3608
Country	:	US
Telephone Number	:	917-756-2526
Fax Number	:	718-606-6189

Provider Business Practice Location Address
First Line	:	3112 MILES AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10465
Country	:	US
Telephone Number	:	917-756-2526
Fax Number	:	718-606-6189

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/28/2009
Last Update Date	:	08/16/2018

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