Individual
CARL MICO ROJALES NATIVIDAD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PT, CLT, CWS
Contact information
Practice address
640 W BROADWAY, LONG BEACH, NY 11561-2900
(516) 431-4400
Mailing address
8995 SWAYING MEADOWS CT, LAS VEGAS, NV 89178-6563
(725) 910-2884
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
044627-01
NY
Other
Enumeration date
08/17/2023
Last updated
08/17/2023
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