Provider Demographics
NPI:1285182113
Name:BESIDO, MARIE GRACE BAUTISTA (TDPT)
Entity Type:Individual
Prefix:
First Name:MARIE GRACE
Middle Name:BAUTISTA
Last Name:BESIDO
Suffix:
Gender:F
Credentials:TDPT
Other - Prefix:
Other - First Name:MARIE GRACE
Other - Middle Name:BESIDO
Other - Last Name:ALIGGAYU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:TDPT
Mailing Address - Street 1:6910 AVENUE U
Mailing Address - Street 2:APT 4P
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-6119
Mailing Address - Country:US
Mailing Address - Phone:718-840-8170
Mailing Address - Fax:
Practice Address - Street 1:2133 RALPH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-5405
Practice Address - Country:US
Practice Address - Phone:718-451-1400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-20
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032419225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist