Individual
JASPER RAYMOND TOLENTINO BAENA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
641 OLD ROUTE 17, MONTICELLO, NY 12701-7014
(845) 794-1400
Mailing address
7 DANICA WAY, UNIT 23, LIBERTY, NY 12754-3360
(213) 712-6052
Taxonomy
Speciality
Code
Description
License number
State
2251P0200X
Pediatric Physical Therapist
Primary
39421-1
NY
Other
Enumeration date
06/09/2016
Last updated
06/09/2016
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