Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 038891 | NY |
N | 2251N0400X | Physical Therapist - Neurology | ||
N | 2251X0800X | Physical Therapist - Orthopedic |
NPI | 1457885295 |
---|---|
Provider Name | Dr. Jacky Mari Cervantes |
First Address | New Rochelle, NY 10804-2120 |
Second Address | Yonkers, NY 10704 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2017 |
Last Update Date | 08/05/2019 |