Provider Demographics
NPI:1902063613
Name:LORESCA DELACRUZ, AVA MAGDALINE (PT, DPT)
Entity type:Individual
Prefix:
First Name:AVA MAGDALINE
Middle Name:
Last Name:LORESCA DELACRUZ
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:755 N BROADWAY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SLEEPY HOLLOW
Mailing Address - State:NY
Mailing Address - Zip Code:10591-1075
Mailing Address - Country:US
Mailing Address - Phone:914-366-3719
Mailing Address - Fax:914-366-1312
Practice Address - Street 1:755 N BROADWAY
Practice Address - Street 2:SUITE 100
Practice Address - City:SLEEPY HOLLOW
Practice Address - State:NY
Practice Address - Zip Code:10591-1075
Practice Address - Country:US
Practice Address - Phone:914-366-3719
Practice Address - Fax:914-366-1312
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-20
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028230225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist