Provider Demographics
NPI:1023364007
Name:ABDALLA, YASSER A (DPT, PHD)
Entity Type:Individual
Prefix:DR
First Name:YASSER
Middle Name:A
Last Name:ABDALLA
Suffix:
Gender:M
Credentials:DPT, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1905 BAY RIDGE PKWY APT 1R
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11204-5715
Mailing Address - Country:US
Mailing Address - Phone:347-788-2430
Mailing Address - Fax:347-602-4631
Practice Address - Street 1:1905 BAY RIDGE PKWY APT 1R
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204-5715
Practice Address - Country:US
Practice Address - Phone:347-788-2430
Practice Address - Fax:347-602-4631
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-27
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030908225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist