Provider Demographics
NPI:1609435338
Name:FLORESTA, LINO S (PT)
Entity Type:Individual
Prefix:
First Name:LINO
Middle Name:S
Last Name:FLORESTA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 S 3RD ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11211-5790
Mailing Address - Country:US
Mailing Address - Phone:718-302-0456
Mailing Address - Fax:718-218-8878
Practice Address - Street 1:601 W 182ND ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033-3903
Practice Address - Country:US
Practice Address - Phone:212-781-7555
Practice Address - Fax:212-781-7550
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-06
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist