Provider Demographics
NPI:1679839211
Name:MARTE, GEOVEDDY MERCEDES (PT)
Entity Type:Individual
Prefix:MS
First Name:GEOVEDDY
Middle Name:MERCEDES
Last Name:MARTE
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 1:60 W 142ND ST
Mailing Address - Street 2:APT. #12L
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10037-1104
Mailing Address - Country:US
Mailing Address - Phone:646-462-2948
Mailing Address - Fax:
Practice Address - Street 1:535 EAST 119 STREET
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10035
Practice Address - Country:US
Practice Address - Phone:212-860-5868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-09
Last Update Date:2012-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031476-12251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics