Provider Demographics
NPI:1225747207
Name:HERNANDEZ, ZENELLE KEESHIA SALA (PT, DPT)
Entity Type:Individual
Prefix:
First Name:ZENELLE KEESHIA
Middle Name:SALA
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:ZENELLE KEESHIA
Other - Middle Name:MORI
Other - Last Name:SALA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:5752 74TH ST APT 1
Mailing Address - Street 2:
Mailing Address - City:MIDDLE VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11379-5253
Mailing Address - Country:US
Mailing Address - Phone:347-324-8566
Mailing Address - Fax:
Practice Address - Street 1:5752 74TH ST APT 1
Practice Address - Street 2:
Practice Address - City:MIDDLE VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11379-5253
Practice Address - Country:US
Practice Address - Phone:347-324-8566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-18
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY041577-01225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty