Provider Demographics
NPI:1134831175
Name:NUNEZ, RAFAEL (DPT)
Entity type:Individual
Prefix:
First Name:RAFAEL
Middle Name:
Last Name:NUNEZ
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3006 33RD ST APT 3E
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11102-1502
Mailing Address - Country:US
Mailing Address - Phone:212-470-1553
Mailing Address - Fax:
Practice Address - Street 1:3006 33RD ST APT 3E
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11102-1502
Practice Address - Country:US
Practice Address - Phone:212-470-1553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-21
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049629-01225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist