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NPI Code Detail

MEDICARE: MS. MARIA LUCIA JIMENEZ-ULLOA P.T.

MEDICARE: MS. MARIA LUCIA JIMENEZ-ULLOA P.T.
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
1225100000XPhysical Therapist024486-1NY

General Provider Information

NPI Number : 1528100989
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. MARIA LUCIA JIMENEZ-ULLOA P.T.
Provider Business Mailing Address
First Line : 3516 85TH ST
Second Line : APT 4H
City : JACKSON HEIGHTS
State : NY
Zip : 11372-5568
Country : US
Telephone Number : 718-457-1662
Fax Number :
Provider Business Practice Location Address
First Line : 20809 UNION TPKE
Second Line :
City : OAKLAND GARDENS
State : NY
Zip : 11364-3235
Country : US
Telephone Number : 718-479-6370
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/13/2007
Last Update Date : 07/08/2007

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