Provider Demographics
NPI:1790969939
Name:ESCOBILLO-GARCES, CATHERINE TABACO (PT)
Entity Type:Individual
Prefix:MRS
First Name:CATHERINE
Middle Name:TABACO
Last Name:ESCOBILLO-GARCES
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 1:8830 51ST AVE APT 5A
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-5549
Mailing Address - Country:US
Mailing Address - Phone:347-320-2767
Mailing Address - Fax:
Practice Address - Street 1:3602 14TH ST
Practice Address - Street 2:
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11106-4704
Practice Address - Country:US
Practice Address - Phone:718-392-2510
Practice Address - Fax:718-392-2637
Is Sole Proprietor?:No
Enumeration Date:2007-12-24
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028863225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q2356Q49E1Medicare PIN