Provider Demographics
NPI:1356383798
Name:MURILLO, BLESILDA (PT)
Entity type:Individual
Prefix:MS
First Name:BLESILDA
Middle Name:
Last Name:MURILLO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4125 53RD ST
Mailing Address - Street 2:APT. 5
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-4280
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4125 53RD ST
Practice Address - Street 2:APT. 5
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-4280
Practice Address - Country:US
Practice Address - Phone:718-426-0176
Practice Address - Fax:718-426-0176
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022459225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist