Provider Demographics
NPI:1235445032
Name:RASCO, CARYL LUISA TABADA
Entity Type:Individual
Prefix:
First Name:CARYL LUISA
Middle Name:TABADA
Last Name:RASCO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7217 18TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11204-5634
Mailing Address - Country:US
Mailing Address - Phone:718-837-7581
Mailing Address - Fax:347-713-3809
Practice Address - Street 1:7217 18TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204-5634
Practice Address - Country:US
Practice Address - Phone:718-837-7581
Practice Address - Fax:347-713-3809
Is Sole Proprietor?:No
Enumeration Date:2010-08-31
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY31132225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist