Provider Demographics
NPI:1073629556
Name:ESCALONA-DEOLALL, ANNA ROCHELLE (PT)
Entity Type:Individual
Prefix:
First Name:ANNA ROCHELLE
Middle Name:
Last Name:ESCALONA-DEOLALL
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 1:1515 SOUTHERN BLVD
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10460-5980
Mailing Address - Country:US
Mailing Address - Phone:718-589-1600
Mailing Address - Fax:718-589-1717
Practice Address - Street 1:1065 SOUTHERN BLVD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10459-2417
Practice Address - Country:US
Practice Address - Phone:718-589-2440
Practice Address - Fax:718-991-4516
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014374225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist