Provider Demographics
NPI:1851610513
Name:REZENDE, MILENA (PT)
Entity Type:Individual
Prefix:
First Name:MILENA
Middle Name:
Last Name:REZENDE
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 1:1641 3RD AVE APT 6J
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-3698
Mailing Address - Country:US
Mailing Address - Phone:917-776-1163
Mailing Address - Fax:646-558-4939
Practice Address - Street 1:1641 3RD AVE APT 6J
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-3698
Practice Address - Country:US
Practice Address - Phone:917-776-1163
Practice Address - Fax:646-558-4939
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-20
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032345-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY032345OtherPHYISCAL THERAPIST LICENSE