Provider Demographics
NPI:1114034030
Name:STRALEY, DOUGLAS GEORGE (ATC)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:GEORGE
Last Name:STRALEY
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5707 HUXLEY AVE
Mailing Address - Street 2:UNIT #1
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10471-2226
Mailing Address - Country:US
Mailing Address - Phone:917-608-5350
Mailing Address - Fax:
Practice Address - Street 1:4513 MANHATTAN COLLEGE PKWY
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10471-4004
Practice Address - Country:US
Practice Address - Phone:718-862-7226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000911-12255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer