Provider Demographics
NPI:1689144156
Name:PLACIO, JUDE (PTA)
Entity Type:Individual
Prefix:
First Name:JUDE
Middle Name:
Last Name:PLACIO
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 E ROUTE 59 STE 112
Mailing Address - Street 2:
Mailing Address - City:NANUET
Mailing Address - State:NY
Mailing Address - Zip Code:10954-2955
Mailing Address - Country:US
Mailing Address - Phone:845-353-3267
Mailing Address - Fax:
Practice Address - Street 1:300 E ROUTE 59 STE 112
Practice Address - Street 2:
Practice Address - City:NANUET
Practice Address - State:NY
Practice Address - Zip Code:10954-2955
Practice Address - Country:US
Practice Address - Phone:845-353-3267
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-27
Last Update Date:2018-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006347225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant