Provider Demographics
NPI:1912674383
Name:RICARTE, ANDRE DOMINIC ROBLES (PTA)
Entity type:Individual
Prefix:
First Name:ANDRE
Middle Name:DOMINIC ROBLES
Last Name:RICARTE
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4735 196TH ST FL 1
Mailing Address - Street 2:
Mailing Address - City:AUBURNDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11358-3934
Mailing Address - Country:US
Mailing Address - Phone:347-601-3637
Mailing Address - Fax:
Practice Address - Street 1:4735 196TH ST FL 1
Practice Address - Street 2:
Practice Address - City:AUBURNDALE
Practice Address - State:NY
Practice Address - Zip Code:11358-3934
Practice Address - Country:US
Practice Address - Phone:347-601-3637
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-24
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010546225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant