Provider Demographics
NPI:1124349519
Name:TAMAYO, ROSE ANN YU (PT)
Entity type:Individual
Prefix:
First Name:ROSE ANN
Middle Name:YU
Last Name:TAMAYO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:ROSE ANN
Other - Middle Name:CLARETE
Other - Last Name:YU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:61 BROADWAY
Mailing Address - Street 2:SUITE 2824
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10006-2701
Mailing Address - Country:US
Mailing Address - Phone:212-981-1977
Mailing Address - Fax:212-643-9192
Practice Address - Street 1:200 W 57TH ST
Practice Address - Street 2:SUITE 900
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-3211
Practice Address - Country:US
Practice Address - Phone:212-981-1977
Practice Address - Fax:212-643-9192
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-19
Last Update Date:2011-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032391-1225100000X
NJ40QA01351100225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist