Provider Demographics
NPI:1033666847
Name:ENRIQUEZ, MARIA LILIBETH (PT)
Entity Type:Individual
Prefix:
First Name:MARIA LILIBETH
Middle Name:
Last Name:ENRIQUEZ
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 1:10933 71ST RD APT 7G
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-4817
Mailing Address - Country:US
Mailing Address - Phone:917-536-3980
Mailing Address - Fax:
Practice Address - Street 1:10933 71ST RD APT 7G
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-4817
Practice Address - Country:US
Practice Address - Phone:917-536-3980
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-09
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020552225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist