Provider Demographics
NPI:1902487168
Name:ABEJERO, PAOLA RUTH BARTOLOME (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:PAOLA RUTH
Middle Name:BARTOLOME
Last Name:ABEJERO
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12326 95TH AVE
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11419-1424
Mailing Address - Country:US
Mailing Address - Phone:443-596-7666
Mailing Address - Fax:
Practice Address - Street 1:12326 95TH AVE
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11419-1424
Practice Address - Country:US
Practice Address - Phone:443-596-7666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-19
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047762225100000X
NY012265225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYNONEMedicaid