Provider Demographics
NPI:1073654398
Name:PUMARADA, REYLITO POLIQUIT (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:REYLITO
Middle Name:POLIQUIT
Last Name:PUMARADA
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 HUNTER AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11703-4602
Mailing Address - Country:US
Mailing Address - Phone:631-669-0415
Mailing Address - Fax:631-669-1455
Practice Address - Street 1:126 HUNTER AVE
Practice Address - Street 2:
Practice Address - City:NORTH BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11703-4602
Practice Address - Country:US
Practice Address - Phone:631-669-0415
Practice Address - Fax:631-669-1455
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2008-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0200302251X0800X, 2251N0400X, 2251G0304X, 225100000X, 2251P0200X, 2251S0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology
No2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports