Provider Demographics
NPI:1568033835
Name:MERCADO, REGINA ROSE PAULO (PT)
Entity Type:Individual
Prefix:
First Name:REGINA ROSE
Middle Name:PAULO
Last Name:MERCADO
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 1:894 ROUTE 308
Mailing Address - Street 2:
Mailing Address - City:RHINEBECK
Mailing Address - State:NY
Mailing Address - Zip Code:12572-3445
Mailing Address - Country:US
Mailing Address - Phone:747-998-3674
Mailing Address - Fax:
Practice Address - Street 1:3 E 65TH ST APT 4A
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-6551
Practice Address - Country:US
Practice Address - Phone:212-535-2621
Practice Address - Fax:212-655-5754
Is Sole Proprietor?:No
Enumeration Date:2021-07-07
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047236225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist