Provider Demographics
NPI:1942441837
Name:VILCHEZ, MARY JANE FERNANDEZ (PT)
Entity Type:Individual
Prefix:MRS
First Name:MARY JANE
Middle Name:FERNANDEZ
Last Name:VILCHEZ
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 1:9059 55TH AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-4560
Mailing Address - Country:US
Mailing Address - Phone:347-681-5812
Mailing Address - Fax:
Practice Address - Street 1:14436 87TH RD
Practice Address - Street 2:
Practice Address - City:BRIARWOOD
Practice Address - State:NY
Practice Address - Zip Code:11435-3124
Practice Address - Country:US
Practice Address - Phone:347-681-5812
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-23
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030162225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist