Provider Demographics
NPI:1598498206
Name:DEQUITO, JESSICA KHLOE CABILAO (PT)
Entity Type:Individual
Prefix:
First Name:JESSICA KHLOE
Middle Name:CABILAO
Last Name:DEQUITO
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 1:9314 95TH ST
Mailing Address - Street 2:
Mailing Address - City:WOODHAVEN
Mailing Address - State:NY
Mailing Address - Zip Code:11421-2709
Mailing Address - Country:US
Mailing Address - Phone:347-744-3290
Mailing Address - Fax:
Practice Address - Street 1:6860 AUSTIN ST
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-4245
Practice Address - Country:US
Practice Address - Phone:718-880-1716
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-08
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY045542225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist