Individual
MR. LOUIE SAMILEY VICENTE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
11045 QUEENS BLVD, FOREST HILLS, NY 11375-5501
(718) 575-5100
Mailing address
8523 BROADWAY APT 2D, ELMHURST, NY 11373-5863
(646) 981-8163
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
008787-01
NY
Other
Enumeration date
03/28/2022
Last updated
03/28/2022
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