Provider Demographics
NPI:1932433380
Name:CLEMENTE, REYNALDO ACUPIDO (PT)
Entity Type:Individual
Prefix:MR
First Name:REYNALDO
Middle Name:ACUPIDO
Last Name:CLEMENTE
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 1:22515 107TH AVE
Mailing Address - Street 2:
Mailing Address - City:QUEENS VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11429-2409
Mailing Address - Country:US
Mailing Address - Phone:516-395-3667
Mailing Address - Fax:
Practice Address - Street 1:5940 164TH ST
Practice Address - Street 2:
Practice Address - City:FRESH MEADOWS
Practice Address - State:NY
Practice Address - Zip Code:11365-1429
Practice Address - Country:US
Practice Address - Phone:516-395-3667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-01
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016986225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist