Provider Demographics
NPI:1477725174
Name:ANIBAL, MARTHA C SR (PT)
Entity Type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:C
Last Name:ANIBAL
Suffix:SR
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 1:31-09 NEWTOWN AVE
Mailing Address - Street 2:SUITE 211
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11102
Mailing Address - Country:US
Mailing Address - Phone:718-728-2277
Mailing Address - Fax:718-728-6945
Practice Address - Street 1:31-09 NEWTOWN AVE
Practice Address - Street 2:SUITE 211
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11102
Practice Address - Country:US
Practice Address - Phone:718-728-2277
Practice Address - Fax:718-728-6945
Is Sole Proprietor?:No
Enumeration Date:2008-04-02
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014965225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist