Provider Demographics
NPI:1942631767
Name:SEGUIA, ERWIN (PT)
Entity Type:Individual
Prefix:
First Name:ERWIN
Middle Name:
Last Name:SEGUIA
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 1:2335 STEINWAY ST
Mailing Address - Street 2:APT 1A
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11105-1579
Mailing Address - Country:US
Mailing Address - Phone:914-500-3547
Mailing Address - Fax:
Practice Address - Street 1:2335 STEINWAY ST
Practice Address - Street 2:APT 1A
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11105-1579
Practice Address - Country:US
Practice Address - Phone:914-500-3547
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-04
Last Update Date:2014-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY037027225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty