MEDICARE: JOHNEMMA MARIE CALIWANAGAN MESA RPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	027704	NY

General Provider Information

NPI Number	:	1366608648
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHNEMMA MARIE CALIWANAGAN MESA RPT

Provider Business Mailing Address
First Line	:	8604 96TH ST APT A6
Second Line	:
City	:	WOODHAVEN
State	:	NY
Zip	:	11421-1751
Country	:	US
Telephone Number	:	347-255-6152
Fax Number	:

Provider Business Practice Location Address
First Line	:	53 ELIZABETH ST FL 3
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10013-4623
Country	:	US
Telephone Number	:	212-966-9818
Fax Number	:	212-966-9189

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/05/2008
Last Update Date	:	12/16/2014

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