Provider Demographics
NPI:1740479799
Name:LAYSA, NESTOR A (PT)
Entity type:Individual
Prefix:
First Name:NESTOR
Middle Name:A
Last Name:LAYSA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:714 BEACH 20TH ST
Mailing Address - Street 2:
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691-3502
Mailing Address - Country:US
Mailing Address - Phone:718-327-7457
Mailing Address - Fax:718-327-7539
Practice Address - Street 1:714 BEACH 20TH ST
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-3502
Practice Address - Country:US
Practice Address - Phone:718-327-7457
Practice Address - Fax:718-327-7539
Is Sole Proprietor?:No
Enumeration Date:2007-10-16
Last Update Date:2010-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05008982A171W00000X
NY030150225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No171W00000XOther Service ProvidersContractor