Provider Demographics
NPI:1942076500
Name:PENACERRADA, EUNICE SOLIMAN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:EUNICE
Middle Name:SOLIMAN
Last Name:PENACERRADA
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 1:1261 CENTRAL AVE APT 406
Mailing Address - Street 2:
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691-4618
Mailing Address - Country:US
Mailing Address - Phone:929-639-2370
Mailing Address - Fax:
Practice Address - Street 1:73 GUY LOMBARDO AVE
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:NY
Practice Address - Zip Code:11520-3714
Practice Address - Country:US
Practice Address - Phone:516-377-3332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-27
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047299225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist