Provider Demographics
NPI:1780868869
Name:VENTURA, MASHEIL (PT)
Entity type:Individual
Prefix:MS
First Name:MASHEIL
Middle Name:
Last Name:VENTURA
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 1:4430 MACNISH ST APT 2A
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-6600
Mailing Address - Country:US
Mailing Address - Phone:718-803-4112
Mailing Address - Fax:
Practice Address - Street 1:26 COURT ST STE 314
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11242-1133
Practice Address - Country:US
Practice Address - Phone:718-797-9111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-25
Last Update Date:2007-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028787225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist