Provider Demographics
NPI:1598988404
Name:VENEZIA, ALICIA (PT)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:VENEZIA
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 1:6715 102ND ST APT 2H
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-2407
Mailing Address - Country:US
Mailing Address - Phone:646-756-0646
Mailing Address - Fax:718-896-0974
Practice Address - Street 1:6715 102ND ST APT 2H
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-2407
Practice Address - Country:US
Practice Address - Phone:646-756-0646
Practice Address - Fax:718-896-0974
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015794-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY015794-1OtherLICENSE