Provider Demographics
NPI:1346555752
Name:ZEZIMA, MICHELE SHERRY (PT)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:SHERRY
Last Name:ZEZIMA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MICHELE
Other - Middle Name:
Other - Last Name:ZEZIMA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT, MS
Mailing Address - Street 1:4411 28TH AVE
Mailing Address - Street 2:APT 3R
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11103-2190
Mailing Address - Country:US
Mailing Address - Phone:646-221-0200
Mailing Address - Fax:
Practice Address - Street 1:4411 28TH AVE
Practice Address - Street 2:APT 3R
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11103-2190
Practice Address - Country:US
Practice Address - Phone:646-221-0200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-10
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY056321225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist