Provider Demographics
NPI:1043955537
Name:PHYSIOTERRA PT PC
Entity Type:Organization
Organization Name:PHYSIOTERRA PT PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KORINA
Authorized Official - Middle Name:AIMEE GAHOL
Authorized Official - Last Name:GALARAGA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:917-742-0221
Mailing Address - Street 1:284 SOMMERVILLE PL
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10703-2225
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3770 103RD ST
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:NY
Practice Address - Zip Code:11368-5390
Practice Address - Country:US
Practice Address - Phone:917-832-7217
Practice Address - Fax:917-832-7486
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-29
Last Update Date:2023-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty