Provider Demographics
NPI:1023244993
Name:ENCABO, MARION AIRA CASTRO (PT)
Entity type:Individual
Prefix:
First Name:MARION AIRA
Middle Name:CASTRO
Last Name:ENCABO
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 1:6782 150TH ST
Mailing Address - Street 2:436B
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-1424
Mailing Address - Country:US
Mailing Address - Phone:917-542-1279
Mailing Address - Fax:
Practice Address - Street 1:6782 150TH ST
Practice Address - Street 2:436B
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367-1424
Practice Address - Country:US
Practice Address - Phone:917-542-1279
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-05
Last Update Date:2009-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023926-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist