Individual
SEPTEMBER GRACE EVANGELISTA BRONO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA,PT,DPT
Contact information
Practice address
615 AVENUE C, BROOKLYN, NY 11218-4101
(718) 633-3300
Mailing address
21726 138TH RD, JAMAICA, NY 11413-2608
(347) 572-2447
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
01219901
NY
Other
Enumeration date
02/03/2023
Last updated
02/03/2023
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