Provider Demographics
NPI:1235800699
Name:REGULACION, RADESSA GEM C
Entity Type:Individual
Prefix:
First Name:RADESSA GEM
Middle Name:C
Last Name:REGULACION
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 1:10318 39TH AVE STE C
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:NY
Mailing Address - Zip Code:11368-2303
Mailing Address - Country:US
Mailing Address - Phone:718-709-7583
Mailing Address - Fax:
Practice Address - Street 1:10318 39TH AVE STE C
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:NY
Practice Address - Zip Code:11368-2303
Practice Address - Country:US
Practice Address - Phone:718-709-7583
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-24
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046385-01225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist