Provider Demographics
NPI:1922205400
Name:POLO, MA CRISTINA VERMON (PT)
Entity Type:Individual
Prefix:MS
First Name:MA CRISTINA
Middle Name:VERMON
Last Name:POLO
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 1:10 BAYLEY AVE
Mailing Address - Street 2:2A
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10705-2926
Mailing Address - Country:US
Mailing Address - Phone:917-353-9630
Mailing Address - Fax:718-367-4047
Practice Address - Street 1:3235 GRAND CONCOURSE
Practice Address - Street 2:SUITE- BASEMENT
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10468-1138
Practice Address - Country:US
Practice Address - Phone:718-367-8800
Practice Address - Fax:718-367-4047
Is Sole Proprietor?:No
Enumeration Date:2007-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027339-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYLICENSE NUMBEROther027339-1