Provider Demographics
NPI:1568896058
Name:HENRIQUES, CHIVONNE S (DPT)
Entity Type:Individual
Prefix:
First Name:CHIVONNE
Middle Name:S
Last Name:HENRIQUES
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 W 57TH ST
Mailing Address - Street 2:10TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-2220
Mailing Address - Country:US
Mailing Address - Phone:212-974-7252
Mailing Address - Fax:
Practice Address - Street 1:145 W 57TH ST
Practice Address - Street 2:10TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-2220
Practice Address - Country:US
Practice Address - Phone:212-974-7252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-03
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY036503225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist