Provider Demographics
NPI:1386253789
Name:VALIENTE, MICHELLE ANGELLI BAGUIO (PHYSICAL THERAPIST A)
Entity type:Individual
Prefix:
First Name:MICHELLE ANGELLI
Middle Name:BAGUIO
Last Name:VALIENTE
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110-45 QUEENS BLVD.
Mailing Address - Street 2:SUITE 105
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-5519
Mailing Address - Country:US
Mailing Address - Phone:646-578-6655
Mailing Address - Fax:
Practice Address - Street 1:110-45 QUEENS BLVD.
Practice Address - Street 2:SUITE 105
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-5519
Practice Address - Country:US
Practice Address - Phone:646-578-6655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-31
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010746225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Single Specialty