Provider Demographics
NPI:1386984516
Name:PREZIOSO, COURTNEY MARIE (MPT)
Entity type:Individual
Prefix:
First Name:COURTNEY MARIE
Middle Name:
Last Name:PREZIOSO
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6525 160TH ST
Mailing Address - Street 2:APT 11B
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11365-2567
Mailing Address - Country:US
Mailing Address - Phone:917-346-6962
Mailing Address - Fax:
Practice Address - Street 1:585 PLANDOME RD
Practice Address - Street 2:
Practice Address - City:MANHASSET
Practice Address - State:NY
Practice Address - Zip Code:11030-1968
Practice Address - Country:US
Practice Address - Phone:516-869-5576
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-25
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032555-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist