Provider Demographics
NPI:1073971198
Name:VENCER, REGINE ALIMONSURIN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:REGINE
Middle Name:ALIMONSURIN
Last Name:VENCER
Suffix:
Gender:F
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 1:20 EAST AVE
Mailing Address - Street 2:
Mailing Address - City:HICKSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11801-4711
Mailing Address - Country:US
Mailing Address - Phone:516-205-1263
Mailing Address - Fax:
Practice Address - Street 1:20 EAST AVE
Practice Address - Street 2:
Practice Address - City:HICKSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11801-4711
Practice Address - Country:US
Practice Address - Phone:516-205-1263
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-03
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY039711225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist