Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 0141941 | NY |
N | 2251X0800X | Physical Therapist - Orthopedic | 0141941 | NY |
NPI | 1053578187 |
---|---|
Provider Name | Mr. Gregory Paul Rakowski |
First Address | Tuckahoe, NY 10707-3911 |
Second Address | New York, NY 10010-6904 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2008 |
Last Update Date | 22/06/2011 |