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General NPI Number Information
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NPI Number | 1457885295
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Entity Type | Individual
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Provider Name | JACKY MARI CERVANTES PT, DPT
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Gender | Male
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Dates
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Enumeration Date | 04/19/2017
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Last Update Date | 05/08/2019
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Provider Practice Location Address
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Address Line | 909 MIDLAND AVE , GROUND FLOOR
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City | YONKERS
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State | NY
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Zip | 10704
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Country | US
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Telephone | 845-553-4607
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Fax |
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Provider Business Mailing Address
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Address Line | 1333A NORTH AVE # 717
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City | NEW ROCHELLE
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State | NY
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Zip | 10804-2120
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Country | US
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Telephone | 845-553-4607
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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 | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2251N0400X
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Taxonomy Name | Neurology Physical Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 038891
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License Number State | NY
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