Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 027922 | NY |
N | 2251G0304X | Physical Therapist - Geriatrics | 027922 | NY |
NPI | 1134484819 |
---|---|
Provider Name | Elizabeth Tamayao |
First Address | Elmhurst, NY 11373-4718 |
Second Address | Elmhurst, NY 11373-4718 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2012 |
Last Update Date | 25/04/2013 |