Provider Demographics
NPI:1457827156
Name:TADY, ANNABELLE VILLAFUERTE (PT)
Entity Type:Individual
Prefix:
First Name:ANNABELLE
Middle Name:VILLAFUERTE
Last Name:TADY
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 1:8610 25TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-4458
Mailing Address - Country:US
Mailing Address - Phone:718-372-6888
Mailing Address - Fax:718-372-5888
Practice Address - Street 1:8610 25TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-4458
Practice Address - Country:US
Practice Address - Phone:718-372-6888
Practice Address - Fax:718-372-5888
Is Sole Proprietor?:No
Enumeration Date:2018-10-19
Last Update Date:2019-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY043009225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY043009OtherNEW YORK STATE LICENSE