Provider Demographics
NPI:1316262553
Name:MORCILLA, MARIA (DPT)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:MORCILLA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:CLARISSA RAYOSO
Other - Last Name:MORCILLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:57-18 WOODSIDE AVE.
Mailing Address - Street 2:STE. B102, BASEMENT LEVEL
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377
Mailing Address - Country:US
Mailing Address - Phone:718-426-7900
Mailing Address - Fax:718-426-7500
Practice Address - Street 1:57-18 WOODSIDE AVE.
Practice Address - Street 2:STE. B102, BASEMENT LEVEL
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377
Practice Address - Country:US
Practice Address - Phone:718-426-7900
Practice Address - Fax:718-426-7500
Is Sole Proprietor?:No
Enumeration Date:2010-03-31
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030029225100000X
NY030029-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist