Provider Demographics
NPI:1043930407
Name:MAUREEN DESEPEDA PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:MAUREEN DESEPEDA PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MAUREEN
Authorized Official - Middle Name:
Authorized Official - Last Name:DESEPEDA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:929-235-6081
Mailing Address - Street 1:4170 72ND ST APT 1
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-3190
Mailing Address - Country:US
Mailing Address - Phone:929-235-6081
Mailing Address - Fax:
Practice Address - Street 1:4170 72ND ST APT 1
Practice Address - Street 2:
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-3190
Practice Address - Country:US
Practice Address - Phone:929-235-6081
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-29
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty