Provider Demographics
NPI:1912540758
Name:QUIOCHO, ALFRED MICHAEL
Entity Type:Individual
Prefix:
First Name:ALFRED
Middle Name:MICHAEL
Last Name:QUIOCHO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:LI PREMIER PHYSICAL AND AQUATIC THERAPY
Mailing Address - Street 2:155 W SUNRISE HIGHWAY
Mailing Address - City:LINDENHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11757
Mailing Address - Country:US
Mailing Address - Phone:631-991-3311
Mailing Address - Fax:
Practice Address - Street 1:LI PREMIER PHYSICAL AND AQUATIC THERAPY
Practice Address - Street 2:155 W SUNRISE HIGHWAY
Practice Address - City:LINDENHURST
Practice Address - State:NY
Practice Address - Zip Code:11757
Practice Address - Country:US
Practice Address - Phone:631-991-3311
Practice Address - Fax:631-991-3309
Is Sole Proprietor?:No
Enumeration Date:2019-10-24
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031704-1225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist