Liliana Fazendeiro, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

0057821 Issued in NY

Practice address

34A Bay St
Sag Harbor, NY 11963-3104

Phone

(631) 356-2631

NPI assigned

Jan 25, 2006

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Manual & Sports Physical Therapy, PC

  • Physical Therapist
  • Southampton, NY
  • NPI 1114907078
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1138147200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692662400000",
    "number": "1992775613",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 VALORIE RD",
            "city": "SOUTHAMPTON",
            "state": "NY",
            "postal_code": "119682308",
            "telephone_number": "631-356-2631"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "34A BAY ST",
            "city": "SAG HARBOR",
            "state": "NY",
            "postal_code": "119633104",
            "telephone_number": "631-356-2631"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAZENDEIRO",
        "first_name": "LILIANA",
        "credential": "PTA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-01-25",
        "last_updated": "2023-08-22",
        "certification_date": "2023-08-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "NY",
            "license": "020287",
            "primary": false
        },
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "NY",
            "license": "0057821",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elise Rachel Duryea, M.A., CCC-SLP
• East End Counseling LCSW PLLC
• East End Sports Chiropractic, PC
• Stephanie Joanne Esposito, LMT, MLDC
• Essential Massage H & W, LLC
• Emily Mara Feinberg, LMSW
• Fighting Chance, Inc
• Sinead Fitzgibbon, PT, PHD
• John Francis French Jr., DMD
• Andrea Michelle Gaines

• Physical Therapy Assistant in Sag Harbor, NY
• Providers in Sag Harbor, NY by specialty
• Physical Therapy Assistant in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.