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General NPI Number Information
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NPI Number | 1518116672
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Entity Type | Individual
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Provider Name | MARTHA OLGA LONDONO PT
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Gender | Female
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Dates
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Enumeration Date | 09/14/2008
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Last Update Date | 09/14/2008
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Provider Practice Location Address
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Address Line | 8829 74TH AVE
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City | GLENDALE
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State | NY
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Zip | 11385-7923
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Country | US
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Telephone | 917-204-6018
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Fax | 718-997-9018
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Provider Business Mailing Address
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Address Line | 8829 74TH AVE
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City | GLENDALE
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State | NY
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Zip | 11385-7923
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Country | US
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Telephone | 917-204-6018
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Fax | 718-997-9018
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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 | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number | 019116-1
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License Number State | NY
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