Provider Demographics
NPI:1518204072
Name:DATU TAHIL, HENLER (PT, DPT)
Entity Type:Individual
Prefix:MR
First Name:HENLER
Middle Name:
Last Name:DATU TAHIL
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1912 LENOX AVE
Mailing Address - Street 2:
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554-4053
Mailing Address - Country:US
Mailing Address - Phone:917-355-7522
Mailing Address - Fax:
Practice Address - Street 1:4055 COLLEGE POINT BLVD
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-5169
Practice Address - Country:US
Practice Address - Phone:917-355-7522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-03
Last Update Date:2020-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030678-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist