Provider Demographics
NPI:1093853806
Name:PEIXOTO, LINTON (PHISICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:LINTON
Middle Name:
Last Name:PEIXOTO
Suffix:
Gender:M
Credentials:PHISICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1324 LOHENGRIN PL
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10465-1326
Mailing Address - Country:US
Mailing Address - Phone:718-597-1511
Mailing Address - Fax:
Practice Address - Street 1:1324 LOHENGRIN PL
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10465-1326
Practice Address - Country:US
Practice Address - Phone:718-597-1511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015895225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist