Provider Demographics
NPI:1245505072
Name:ANG, MARIA THERESA YELO (PT)
Entity type:Individual
Prefix:MS
First Name:MARIA THERESA
Middle Name:YELO
Last Name:ANG
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 1:3429 69TH ST FL 1
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-2330
Mailing Address - Country:US
Mailing Address - Phone:347-426-7439
Mailing Address - Fax:
Practice Address - Street 1:75-10 21ST AVENUE
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11370-2330
Practice Address - Country:US
Practice Address - Phone:718-728-1459
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-13
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022332225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist