Provider Demographics
NPI:1134638398
Name:RAZON, JAYCEE CATEDRAL (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:JAYCEE
Middle Name:CATEDRAL
Last Name:RAZON
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3713 E TREMONT AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10465-2054
Mailing Address - Country:US
Mailing Address - Phone:718-597-4878
Mailing Address - Fax:718-597-4877
Practice Address - Street 1:3713 E TREMONT AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10465-2054
Practice Address - Country:US
Practice Address - Phone:718-597-4878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-20
Last Update Date:2017-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY041592225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist