Provider Demographics
NPI:1316692973
Name:PATRIMONIO, CARMELA MAE Q (PTA, PT)
Entity type:Individual
Prefix:
First Name:CARMELA MAE
Middle Name:Q
Last Name:PATRIMONIO
Suffix:
Gender:F
Credentials:PTA, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 RICHARD AVE
Mailing Address - Street 2:
Mailing Address - City:HICKSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11801-1224
Mailing Address - Country:US
Mailing Address - Phone:929-622-6081
Mailing Address - Fax:
Practice Address - Street 1:737 COMMACK RD
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:NY
Practice Address - Zip Code:11717-7407
Practice Address - Country:US
Practice Address - Phone:631-388-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-12
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012400-01225200000X
NY045251-01225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant