Provider Demographics
NPI:1679108716
Name:CABRERA, LINA
Entity Type:Individual
Prefix:
First Name:LINA
Middle Name:
Last Name:CABRERA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 PLITT AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH FARMINGDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11735-5125
Mailing Address - Country:US
Mailing Address - Phone:347-744-3119
Mailing Address - Fax:
Practice Address - Street 1:200 E MAIN ST
Practice Address - Street 2:
Practice Address - City:PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-3159
Practice Address - Country:US
Practice Address - Phone:631-654-9400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-09
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044007225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist