Provider Demographics
NPI:1023739240
Name:CARDENAS, ANA THERESA ALCOBA (PT)
Entity type:Individual
Prefix:
First Name:ANA THERESA
Middle Name:ALCOBA
Last Name:CARDENAS
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 1:3400 TRYON AVE APT C4
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-2562
Mailing Address - Country:US
Mailing Address - Phone:929-408-5834
Mailing Address - Fax:
Practice Address - Street 1:1732 DAVIDSON AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10453-7804
Practice Address - Country:US
Practice Address - Phone:718-299-6892
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-06
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040388225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist