Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 040027-1 | NY |
N | 2251X0800X | Physical Therapist - Orthopedic | 040027-1 | NY |
NPI | 1063873289 |
---|---|
Provider Name | Liat Chana Avital |
First Address | Great Neck, NY 11021-4802 |
Second Address | Great Neck, NY 11021-4802 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/03/2016 |
Last Update Date | 13/12/2018 |