Provider Demographics
NPI:1851010193
Name:EMPEDRADO, KHARIZZA ALLETH BOTE (PT)
Entity Type:Individual
Prefix:
First Name:KHARIZZA ALLETH
Middle Name:BOTE
Last Name:EMPEDRADO
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 1:9019 88TH AVE APT F14
Mailing Address - Street 2:
Mailing Address - City:WOODHAVEN
Mailing Address - State:NY
Mailing Address - Zip Code:11421-2109
Mailing Address - Country:US
Mailing Address - Phone:917-805-1519
Mailing Address - Fax:
Practice Address - Street 1:9019 88TH AVE APT F14
Practice Address - Street 2:
Practice Address - City:WOODHAVEN
Practice Address - State:NY
Practice Address - Zip Code:11421-2109
Practice Address - Country:US
Practice Address - Phone:917-805-1519
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-22
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048260225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist