Provider Demographics
NPI:1427819580
Name:DIMAANO, ADRIAN
Entity type:Individual
Prefix:MISS
First Name:ADRIAN
Middle Name:
Last Name:DIMAANO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11048 72ND AVE APT 4H
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-4940
Mailing Address - Country:US
Mailing Address - Phone:508-410-5625
Mailing Address - Fax:
Practice Address - Street 1:11048 72ND AVE APT 4H
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-4940
Practice Address - Country:US
Practice Address - Phone:508-410-5625
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-17
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013678225200000X
NY051787225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant