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General NPI Number Information
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NPI Number | 1922732809
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Entity Type | Individual
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Provider Name | CHARMAINE IRISH LONGAKIT JUARIO PT
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Gender | Female
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Dates
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Enumeration Date | 07/15/2022
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Last Update Date | 07/15/2022
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Provider Practice Location Address
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Address Line | 1345 AVENUE OF THE AMERICAS 11TH FLOOR
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City | NEW YORK
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State | NY
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Zip | 10105
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Country | US
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Telephone | 212-981-1977
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Fax | 646-786-4026
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Provider Business Mailing Address
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Address Line | 24 SUNNYSIDE DR
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City | SPRINGFIELD
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State | IL
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Zip | 62702
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Country | US
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Telephone | 217-610-0058
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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 | 041321
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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 | 070023561
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License Number State | IL
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