Provider Demographics
NPI:1154565125
Name:THEOGENE, ANNE CAROLINE (DPT)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:CAROLINE
Last Name:THEOGENE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11406 227TH ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIA HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11411-1321
Mailing Address - Country:US
Mailing Address - Phone:516-477-6573
Mailing Address - Fax:718-228-9381
Practice Address - Street 1:11406 227TH ST
Practice Address - Street 2:
Practice Address - City:CAMBRIA HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11411-1321
Practice Address - Country:US
Practice Address - Phone:516-477-6573
Practice Address - Fax:718-228-9381
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-21
Last Update Date:2009-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028994-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist