Provider Demographics
NPI:1205693819
Name:GA PHYSICAL THERAPY FOR ALL PC
Entity type:Organization
Organization Name:GA PHYSICAL THERAPY FOR ALL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PT
Authorized Official - Prefix:
Authorized Official - First Name:GYULNARA
Authorized Official - Middle Name:
Authorized Official - Last Name:AVSHALUMOVA
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:917-697-2617
Mailing Address - Street 1:38 CORAL CT
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10308-3534
Mailing Address - Country:US
Mailing Address - Phone:917-697-2617
Mailing Address - Fax:
Practice Address - Street 1:38 CORAL CT
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10308-3534
Practice Address - Country:US
Practice Address - Phone:917-697-2617
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-29
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty