Provider Demographics
NPI:1417268129
Name:YBANEZ, MARIA LUISA (PT)
Entity Type:Individual
Prefix:
First Name:MARIA LUISA
Middle Name:
Last Name:YBANEZ
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 1:112 BIDWELL AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-3177
Mailing Address - Country:US
Mailing Address - Phone:718-637-4603
Mailing Address - Fax:718-448-8287
Practice Address - Street 1:184 JAMIE LN
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312-6614
Practice Address - Country:US
Practice Address - Phone:646-403-0510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-28
Last Update Date:2017-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023614-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist