Provider Demographics
NPI:1164296349
Name:FLORES, MHARENZ GATUS (PTA)
Entity Type:Individual
Prefix:
First Name:MHARENZ
Middle Name:GATUS
Last Name:FLORES
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8427 102ND AVE
Mailing Address - Street 2:
Mailing Address - City:OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11416-2028
Mailing Address - Country:US
Mailing Address - Phone:929-698-6617
Mailing Address - Fax:
Practice Address - Street 1:8427 102ND AVE
Practice Address - Street 2:
Practice Address - City:OZONE PARK
Practice Address - State:NY
Practice Address - Zip Code:11416-2028
Practice Address - Country:US
Practice Address - Phone:929-698-6617
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-08
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY01395901225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant