Provider Demographics
NPI:1316077308
Name:BARRETTO, MIMILANIE DAYAUON (PT)
Entity type:Individual
Prefix:
First Name:MIMILANIE
Middle Name:DAYAUON
Last Name:BARRETTO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 TINDER LN
Mailing Address - Street 2:
Mailing Address - City:LEVITTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11756-3452
Mailing Address - Country:US
Mailing Address - Phone:718-877-0535
Mailing Address - Fax:
Practice Address - Street 1:111 WEST OLD COUNTY ROAD
Practice Address - Street 2:UNIT 1, LOWER LEVEL
Practice Address - City:HICKSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11801-1180
Practice Address - Country:US
Practice Address - Phone:516-433-4570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2019-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026519225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ7295EQ711Medicare PIN
NYA400010172Medicare PIN
NYA400010174Medicare PIN