Provider Demographics
NPI:1902131485
Name:DURAN, ALGLYN BERMILLO (PT)
Entity Type:Individual
Prefix:MR
First Name:ALGLYN
Middle Name:BERMILLO
Last Name:DURAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16605 HIGHLAND AVE
Mailing Address - Street 2:APT 7Y
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-2617
Mailing Address - Country:US
Mailing Address - Phone:347-255-3564
Mailing Address - Fax:
Practice Address - Street 1:16605 HIGHLAND AVE
Practice Address - Street 2:APT 7Y
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-2617
Practice Address - Country:US
Practice Address - Phone:347-255-3564
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-16
Last Update Date:2009-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026340225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist