Provider Demographics
NPI:1801181029
Name:ISIDRO, MA FATIMA C (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:MA FATIMA
Middle Name:C
Last Name:ISIDRO
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:562 OXFORD RD
Mailing Address - Street 2:
Mailing Address - City:CEDARHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11516-1023
Mailing Address - Country:US
Mailing Address - Phone:347-276-8608
Mailing Address - Fax:
Practice Address - Street 1:800 MANOR RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-7036
Practice Address - Country:US
Practice Address - Phone:718-477-7960
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-15
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027135225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY027135OtherPHYSICAL THERAPY LICENSE NUMBER