Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 016341 | NY |
NPI | 1215113873 |
---|---|
Provider Name | David Glowatz |
First Address | Queens Village, NY 11427-1217 |
Second Address | Queens Village, NY 11427-1217 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/01/2008 |
Last Update Date | 14/01/2008 |