Provider Demographics
NPI:1336478940
Name:CAUSON, MARIA THERESA (RPT)
Entity Type:Individual
Prefix:
First Name:MARIA THERESA
Middle Name:
Last Name:CAUSON
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:265 MILL RD APT 5N
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-4726
Mailing Address - Country:US
Mailing Address - Phone:347-934-3254
Mailing Address - Fax:
Practice Address - Street 1:265 MILL RD APT 5N
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-4726
Practice Address - Country:US
Practice Address - Phone:347-934-3254
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-10
Last Update Date:2009-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032183225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist