Provider Demographics
NPI:1679616106
Name:OSTOP, MARY VIRGINIA (PT)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:VIRGINIA
Last Name:OSTOP
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:MARY
Other - Middle Name:VIRGINIA
Other - Last Name:LA ROSA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1761 HORATIO AVE
Mailing Address - Street 2:
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-2948
Mailing Address - Country:US
Mailing Address - Phone:516-546-6289
Mailing Address - Fax:516-546-6289
Practice Address - Street 1:1761 HORATIO AVE
Practice Address - Street 2:
Practice Address - City:MERRICK
Practice Address - State:NY
Practice Address - Zip Code:11566-2948
Practice Address - Country:US
Practice Address - Phone:516-546-6289
Practice Address - Fax:516-546-6289
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006852-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist