Provider Demographics
NPI:1033127790
Name:BIONDI, MARYALICE OSHANA (PT)
Entity Type:Individual
Prefix:
First Name:MARYALICE
Middle Name:OSHANA
Last Name:BIONDI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 715
Mailing Address - Street 2:
Mailing Address - City:BREWSTER
Mailing Address - State:MA
Mailing Address - Zip Code:02631-0715
Mailing Address - Country:US
Mailing Address - Phone:415-302-8393
Mailing Address - Fax:
Practice Address - Street 1:1 INDEPENDENCE WAY
Practice Address - Street 2:
Practice Address - City:BREWSTER
Practice Address - State:MA
Practice Address - Zip Code:02631-1906
Practice Address - Country:US
Practice Address - Phone:415-302-8393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPTL6961225100000X
CAOPT153480225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q17785Medicare UPIN
OPT153480Medicare ID - Type Unspecified