Provider Demographics
NPI:1477792224
Name:CALICA, GERTRUDE REMOROZO (PT)
Entity Type:Individual
Prefix:MS
First Name:GERTRUDE
Middle Name:REMOROZO
Last Name:CALICA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:GERTRUDE CORDILYN
Other - Middle Name:REMOROZO
Other - Last Name:CALICA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:260 MIDDLE COUNTRY RD
Mailing Address - Street 2:# 9A
Mailing Address - City:SELDEN
Mailing Address - State:NY
Mailing Address - Zip Code:11784-2568
Mailing Address - Country:US
Mailing Address - Phone:631-732-1600
Mailing Address - Fax:631-732-7872
Practice Address - Street 1:260 MIDDLE COUNTRY RD
Practice Address - Street 2:# 9A
Practice Address - City:SELDEN
Practice Address - State:NY
Practice Address - Zip Code:11784-2568
Practice Address - Country:US
Practice Address - Phone:631-732-1600
Practice Address - Fax:631-732-7872
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-17
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028821225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist