Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 020030 | NY |
N | 2251G0304X | Physical Therapist - Geriatrics | 020030 | NY |
N | 2251N0400X | Physical Therapist - Neurology | 020030 | NY |
Y | 2251P0200X | Physical Therapist - Pediatrics | 020030 | NY |
N | 2251S0007X | Physical Therapist - Sports | 020030 | NY |
N | 2251X0800X | Physical Therapist - Orthopedic | 020030 | NY |
NPI | 1073654398 |
---|---|
Provider Name | Dr. Reylito Poliquit Pumarada |
First Address | North Babylon, NY 11703-4602 |
Second Address | North Babylon, NY 11703-4602 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/02/2007 |
Last Update Date | 27/10/2008 |