Provider Demographics
NPI:1639844434
Name:ANTIPUESTO, KIA NICHOLE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:KIA NICHOLE
Middle Name:
Last Name:ANTIPUESTO
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8808 JUSTICE AVE APT 9N
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-5338
Mailing Address - Country:US
Mailing Address - Phone:916-895-4726
Mailing Address - Fax:
Practice Address - Street 1:140-40 SANFORD AVENUE
Practice Address - Street 2:
Practice Address - City:QUEENS
Practice Address - State:NY
Practice Address - Zip Code:11355-2556
Practice Address - Country:US
Practice Address - Phone:718-353-1400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-12
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY045667225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist