Provider Demographics
NPI:1225357866
Name:OIESTAD, DENISE (PT)
Entity type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:
Last Name:OIESTAD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:DENISE
Other - Middle Name:OIESTAD
Other - Last Name:DITO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:519 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10310-2845
Mailing Address - Country:US
Mailing Address - Phone:718-442-4878
Mailing Address - Fax:718-442-4878
Practice Address - Street 1:519 BROADWAY
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10310-2845
Practice Address - Country:US
Practice Address - Phone:718-442-4878
Practice Address - Fax:718-442-4878
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-21
Last Update Date:2010-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013937-12251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics