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General NPI Number Information
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NPI Number | 1619195518
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Entity Type | Individual
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Provider Name | FILIPINAS NACIANCENO PHYSICAL THERAPIST
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Gender | Female
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Dates
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Enumeration Date | 04/23/2007
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Last Update Date | 05/27/2012
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Provider Practice Location Address
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Address Line | 8902 32ND AVE
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City | EAST ELMHURST
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State | NY
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Zip | 11369-2238
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Country | US
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Telephone | 718-779-5895
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Fax |
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Provider Business Mailing Address
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Address Line | 8902 32ND AVE
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City | EAST ELMHURST
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State | NY
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Zip | 11369-2238
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Country | US
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Telephone | 718-898-8181
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 40QA01113400
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number | 023745
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License Number State | NY
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