Provider Demographics
NPI:1417100231
Name:PICZON, IDA MARIE UY (PT)
Entity Type:Individual
Prefix:
First Name:IDA MARIE
Middle Name:UY
Last Name:PICZON
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 1:18 ALEXANDER ST
Mailing Address - Street 2:
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06830-6204
Mailing Address - Country:US
Mailing Address - Phone:203-542-5443
Mailing Address - Fax:203-542-5443
Practice Address - Street 1:18 ALEXANDER ST
Practice Address - Street 2:
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06830-6204
Practice Address - Country:US
Practice Address - Phone:203-542-5443
Practice Address - Fax:203-542-5443
Is Sole Proprietor?:No
Enumeration Date:2008-10-23
Last Update Date:2008-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018333225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist