Provider Demographics
NPI:1689817157
Name:TOLENTINO, MICHELLE CHERRY
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:CHERRY
Last Name:TOLENTINO
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 1:3304 WATERBURY AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10465-1554
Mailing Address - Country:US
Mailing Address - Phone:718-931-3000
Mailing Address - Fax:718-514-8228
Practice Address - Street 1:3304 WATERBURY AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10465-1554
Practice Address - Country:US
Practice Address - Phone:718-931-3000
Practice Address - Fax:718-514-8228
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-14
Last Update Date:2009-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030737-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist