Provider Demographics
NPI:1922587443
Name:ABELLA, CRESILDA TEJANO
Entity Type:Individual
Prefix:
First Name:CRESILDA
Middle Name:TEJANO
Last Name:ABELLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4207 161ST STREET
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11358-4159
Mailing Address - Country:US
Mailing Address - Phone:646-520-7600
Mailing Address - Fax:
Practice Address - Street 1:SUMMIT CARE PHYSICAL THERAPY P.C.
Practice Address - Street 2:37-59 61ST STREET UNIT M2
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-2567
Practice Address - Country:US
Practice Address - Phone:718-424-2273
Practice Address - Fax:718-424-2278
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-07
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042680225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist