Provider Demographics
NPI:1497908420
Name:CHARUPAKORN, MA CELESTE GALERA (PT)
Entity Type:Individual
Prefix:
First Name:MA CELESTE
Middle Name:GALERA
Last Name:CHARUPAKORN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MA CELESTE
Other - Middle Name:FLORES
Other - Last Name:GALERA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:260 E 188TH ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10458-5302
Mailing Address - Country:US
Mailing Address - Phone:718-960-6173
Mailing Address - Fax:718-960-9397
Practice Address - Street 1:260 E 188TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458-5302
Practice Address - Country:US
Practice Address - Phone:718-960-6173
Practice Address - Fax:718-960-9397
Is Sole Proprietor?:No
Enumeration Date:2008-11-04
Last Update Date:2016-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022233225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist