Most Relevant Information
Provider Data
| NPI Number: | 1003492091 |
| Provider Name: | MARIA HEIDI DE LOS REYES BAGONGON PT |
| Entity Type: | Individual |
| Taxonomy Code: | 225100000X |
| Specialty: | Physical Therapist |
| License Number: | 041143 |
Most Important Dates
| Enumeration Date: | 03/22/2021 |
| Last Updated: | 03/22/2021 |
Provider Practice Location
111 WADSWORTH AVE
NEW YORK
NY
100336102
Practice Location Phone/Fax
| Phone: | 2127407400 |
| Fax: | 2127407408 |
Provider Mailing Location
3563 BAINBRIDGE AVE APT 6C
BRONX
NY
104671440
Provider Mailing Phone/Fax
| Phone: | 6174126234 |
| Fax: |