Provider Demographics
NPI:1255425963
Name:TUAZON, MARICEL LOYOLA
Entity type:Individual
Prefix:MS
First Name:MARICEL
Middle Name:LOYOLA
Last Name:TUAZON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARICEL
Other - Middle Name:LOYOLA
Other - Last Name:TUAZON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:15 CEDARLAWN BLVD
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580-2001
Mailing Address - Country:US
Mailing Address - Phone:516-561-6854
Mailing Address - Fax:516-561-6854
Practice Address - Street 1:2900 HEMPSTEAD TPKE
Practice Address - Street 2:
Practice Address - City:LEVITTOWN
Practice Address - State:NY
Practice Address - Zip Code:11756-1404
Practice Address - Country:US
Practice Address - Phone:516-731-0303
Practice Address - Fax:516-731-6302
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023060225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist