Provider Demographics
NPI:1295876324
Name:FAUSTINO, GIASAPPH MARY DACANAY (PT)
Entity type:Individual
Prefix:
First Name:GIASAPPH MARY
Middle Name:DACANAY
Last Name:FAUSTINO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:GIASAPPH MARY
Other - Middle Name:FAUSTINO
Other - Last Name:CUETO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:25 WRIGHT AVE
Mailing Address - Street 2:
Mailing Address - City:LYNBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11563-2320
Mailing Address - Country:US
Mailing Address - Phone:516-837-3457
Mailing Address - Fax:516-776-9695
Practice Address - Street 1:25 WRIGHT AVE
Practice Address - Street 2:
Practice Address - City:LYNBROOK
Practice Address - State:NY
Practice Address - Zip Code:11563-2320
Practice Address - Country:US
Practice Address - Phone:516-837-3457
Practice Address - Fax:516-776-9695
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-10
Last Update Date:2009-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019728-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist