Provider Demographics
NPI:1629020557
Name:SENCIO, EGBERT ROLLORATA (PT)
Entity Type:Individual
Prefix:
First Name:EGBERT
Middle Name:ROLLORATA
Last Name:SENCIO
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 1:55 NORTHERN BLVD
Mailing Address - Street 2:STE. 103
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-4058
Mailing Address - Country:US
Mailing Address - Phone:516-466-9300
Mailing Address - Fax:516-466-9253
Practice Address - Street 1:55 NORTHERN BLVD
Practice Address - Street 2:STE. 103
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-4058
Practice Address - Country:US
Practice Address - Phone:516-466-9300
Practice Address - Fax:516-466-9353
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2015-10-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY027976225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist