Provider Demographics
NPI:1992832349
Name:AZCUE, MIA E (PT)
Entity Type:Individual
Prefix:
First Name:MIA
Middle Name:E
Last Name:AZCUE
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 1:11 QUAIL RDG
Mailing Address - Street 2:
Mailing Address - City:PUTNAM VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10579-3108
Mailing Address - Country:US
Mailing Address - Phone:845-528-8565
Mailing Address - Fax:
Practice Address - Street 1:21 PEEKSKILL HOLLOW RD STE 201
Practice Address - Street 2:
Practice Address - City:PUTNAM VALLEY
Practice Address - State:NY
Practice Address - Zip Code:10579-3254
Practice Address - Country:US
Practice Address - Phone:845-528-3133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY11211-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist