Provider Demographics
NPI:1932652476
Name:PENA, RICHARD (PT)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:PENA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 MOORE ST
Mailing Address - Street 2:APARTMENT 22T
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11206-3958
Mailing Address - Country:US
Mailing Address - Phone:917-553-8247
Mailing Address - Fax:
Practice Address - Street 1:29 MOORE ST
Practice Address - Street 2:APARTMENT 22T
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11206-3958
Practice Address - Country:US
Practice Address - Phone:917-553-8247
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-02
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist