Individual
KHEA MEL ESTORNINOS PERALES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
4139 70TH ST APT WOODSIDE, WOODSIDE, NY 11377-8122
(719) 660-7641
Mailing address
4139 70TH ST APT WOODSIDE, WOODSIDE, NY 11377-8122
(719) 660-7641
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
013089-01
NY
Other
Enumeration date
03/02/2022
Last updated
03/02/2022
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