Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 027684 | NY |
Y | 225100000X | Physical Therapist | 027684-1 | NY |
NPI | 1003112103 |
---|---|
Provider Name | Tania Registre |
First Address | Bay Shore, NY 11706-2606 |
Second Address | North Babylon, NY 11703-3403 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/02/2011 |
Last Update Date | 31/08/2021 |