Provider Demographics
NPI:1538435367
Name:RIOS, LORENA B (PT)
Entity type:Individual
Prefix:MRS
First Name:LORENA
Middle Name:B
Last Name:RIOS
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 1:11436 202ND ST
Mailing Address - Street 2:
Mailing Address - City:SAINT ALBANS
Mailing Address - State:NY
Mailing Address - Zip Code:11412-2813
Mailing Address - Country:US
Mailing Address - Phone:718-776-4500
Mailing Address - Fax:718-224-5914
Practice Address - Street 1:11436 202ND ST
Practice Address - Street 2:
Practice Address - City:SAINT ALBANS
Practice Address - State:NY
Practice Address - Zip Code:11412-2813
Practice Address - Country:US
Practice Address - Phone:718-776-4500
Practice Address - Fax:718-224-5914
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-27
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019461225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist