Provider Demographics
NPI:1891741401
Name:BARROSO TANLIOCO, MARIBEL B (PT, DPT)
Entity Type:Individual
Prefix:
First Name:MARIBEL
Middle Name:B
Last Name:BARROSO TANLIOCO
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 1:1991 MARCUS AVENUE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:LAKE SUCCESS
Mailing Address - State:NY
Mailing Address - Zip Code:11042-2057
Mailing Address - Country:US
Mailing Address - Phone:516-466-4700
Mailing Address - Fax:516-466-4810
Practice Address - Street 1:1991 MARCUS AVENUE
Practice Address - Street 2:SUITE 110
Practice Address - City:LAKE SUCCESS
Practice Address - State:NY
Practice Address - Zip Code:11042-2057
Practice Address - Country:US
Practice Address - Phone:516-466-4700
Practice Address - Fax:516-466-4810
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2019-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024092225100000X
NY024092-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY024092OtherLICENSE