Provider Demographics
NPI:1164629507
Name:ILETO, MARICRIS BELZA (PTA)
Entity Type:Individual
Prefix:
First Name:MARICRIS
Middle Name:BELZA
Last Name:ILETO
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:MARICRIS
Other - Middle Name:ILETO
Other - Last Name:DELACRUZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:17 PAERDEGAT 11 ST.
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-4117
Mailing Address - Country:US
Mailing Address - Phone:718-975-8025
Mailing Address - Fax:718-975-8025
Practice Address - Street 1:17 PAERDEGAT 11TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236-4117
Practice Address - Country:US
Practice Address - Phone:718-975-8025
Practice Address - Fax:718-975-8025
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005909-1225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant