Provider Demographics
NPI:1942408125
Name:QUIJOTE, HEPSHIBA RITA S (PT)
Entity Type:Individual
Prefix:
First Name:HEPSHIBA RITA
Middle Name:S
Last Name:QUIJOTE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:HEPSHIBA RITA
Other - Middle Name:P
Other - Last Name:SERING
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:68-12 37TH RD.
Mailing Address - Street 2:#601
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377
Mailing Address - Country:US
Mailing Address - Phone:646-703-4462
Mailing Address - Fax:
Practice Address - Street 1:68-12 37TH RD.
Practice Address - Street 2:#601
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377
Practice Address - Country:US
Practice Address - Phone:646-703-4462
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
NY021939225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY21939OtherLICENSE NUMBER