Healthcare Provider Details

I. General information

NPI: 1336836071
Provider Name (Legal Business Name): PAULA ANDREA HURTADO RENGIFO PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2023
Last Update Date: 02/02/2024
Certification Date: 02/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

139 E 57TH ST FL 2ND AND 3RD FLOOR
NEW YORK NY
10022-2102
US

IV. Provider business mailing address

1255 5TH AVE SUITE 6L
NEW YORK NY
10029
US

V. Phone/Fax

Practice location:
  • Phone: 212-753-4767
  • Fax: 212-753-4076
Mailing address:
  • Phone: 914-400-1500
  • Fax: 914-478-8781

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number050228
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: