Provider Demographics
NPI:1396840799
Name:C FETALCO, MARIA DONNA (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:DONNA
Last Name:C FETALCO
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
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Mailing Address - Street 1:263 7TH AVENUE
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-3689
Mailing Address - Country:US
Mailing Address - Phone:718-369-8000
Mailing Address - Fax:718-369-8038
Practice Address - Street 1:263 7TH AVENUE
Practice Address - Street 2:SUITE 2A
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-3689
Practice Address - Country:US
Practice Address - Phone:718-369-8000
Practice Address - Fax:718-369-8038
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY023992-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist