Provider Demographics
NPI:1316182264
Name:POTAPENKOVA, NINA (PT)
Entity Type:Individual
Prefix:
First Name:NINA
Middle Name:
Last Name:POTAPENKOVA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16242 97TH ST
Mailing Address - Street 2:
Mailing Address - City:HOWARD BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11414-4030
Mailing Address - Country:US
Mailing Address - Phone:646-331-7172
Mailing Address - Fax:718-641-9088
Practice Address - Street 1:16242 97TH ST
Practice Address - Street 2:
Practice Address - City:HOWARD BEACH
Practice Address - State:NY
Practice Address - Zip Code:11414-4030
Practice Address - Country:US
Practice Address - Phone:646-331-7172
Practice Address - Fax:718-641-9088
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-06
Last Update Date:2008-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019990225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist