Provider Demographics
NPI:1578945465
Name:MINGOA, SERYL (PTA)
Entity Type:Individual
Prefix:
First Name:SERYL
Middle Name:
Last Name:MINGOA
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 1:620 REISS PL APT 2E
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-8049
Mailing Address - Country:US
Mailing Address - Phone:347-406-1188
Mailing Address - Fax:
Practice Address - Street 1:729 PELHAM PKWY N
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-9506
Practice Address - Country:US
Practice Address - Phone:718-944-5050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-26
Last Update Date:2015-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008280225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant