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General NPI Number Information
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NPI Number | 1245892736
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Entity Type | Individual
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Provider Name | TREXY LYNN DURAN AGUIRRE
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Gender | Female
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Dates
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Enumeration Date | 07/03/2019
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Last Update Date | 03/03/2022
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Provider Practice Location Address
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Address Line | 14 DOTY AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10305-4721
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Country | US
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Telephone | 917-831-2956
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Fax |
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Provider Business Mailing Address
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Address Line | 14 DOTY AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10305-4721
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Country | US
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Telephone | 917-831-2956
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 036417
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 036417
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License Number State | NY
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