Provider Demographics
NPI:1376877324
Name:GAPUZAN, ROMINA (PT)
Entity Type:Individual
Prefix:MRS
First Name:ROMINA
Middle Name:
Last Name:GAPUZAN
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 1:17218 HIGHLAND AVE APT 1F
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-2844
Mailing Address - Country:US
Mailing Address - Phone:917-442-2207
Mailing Address - Fax:
Practice Address - Street 1:17218 HIGHLAND AVE APT 1F
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-2844
Practice Address - Country:US
Practice Address - Phone:917-442-2207
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-23
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY27111225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist