Provider Demographics
NPI:1700827912
Name:ESCOBIA-OCAMPO, MA THERESA TIPON (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:MA THERESA
Middle Name:TIPON
Last Name:ESCOBIA-OCAMPO
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:133 WOODLAWN AVEVENUE
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11581
Mailing Address - Country:US
Mailing Address - Phone:216-825-2456
Mailing Address - Fax:
Practice Address - Street 1:227 MADISON STREET
Practice Address - Street 2:GOUVERNEUR HEALTHCARE SERVICES
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10002
Practice Address - Country:US
Practice Address - Phone:212-238-7891
Practice Address - Fax:212-238-8006
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY013890225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist