Provider Demographics
NPI:1568044964
Name:PABATAO, MARIA CONNIE GRACE (PTA)
Entity Type:Individual
Prefix:
First Name:MARIA CONNIE GRACE
Middle Name:
Last Name:PABATAO
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1012 HOLLYWOOD AVE # 2
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10465-2160
Mailing Address - Country:US
Mailing Address - Phone:646-436-4077
Mailing Address - Fax:
Practice Address - Street 1:1012 HOLLYWOOD AVE # 2
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10465-2160
Practice Address - Country:US
Practice Address - Phone:646-436-4077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-25
Last Update Date:2021-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007274225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant