Provider Demographics
NPI:1891480562
Name:PALMA, RICHIELADY SUMANQUI (RPT)
Entity Type:Individual
Prefix:
First Name:RICHIELADY
Middle Name:SUMANQUI
Last Name:PALMA
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5226 VAN LOON ST FL 2
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-4256
Mailing Address - Country:US
Mailing Address - Phone:347-242-4216
Mailing Address - Fax:
Practice Address - Street 1:5226 VAN LOON ST FL 2
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-4256
Practice Address - Country:US
Practice Address - Phone:347-242-4216
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-10
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044726-01225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist