Provider Demographics
NPI:1275704173
Name:GARROVILLAS, JEFFERSON GARCIA (PT)
Entity Type:Individual
Prefix:
First Name:JEFFERSON
Middle Name:GARCIA
Last Name:GARROVILLAS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 SCENIC DR APT P
Mailing Address - Street 2:
Mailing Address - City:CROTON ON HUDSON
Mailing Address - State:NY
Mailing Address - Zip Code:10520-1821
Mailing Address - Country:US
Mailing Address - Phone:646-479-9214
Mailing Address - Fax:
Practice Address - Street 1:27 SCENIC DR APT P
Practice Address - Street 2:
Practice Address - City:CROTON ON HUDSON
Practice Address - State:NY
Practice Address - Zip Code:10520-1821
Practice Address - Country:US
Practice Address - Phone:646-479-9214
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-18
Last Update Date:2022-12-01
Deactivation Date:2022-11-18
Deactivation Code:
Reactivation Date:2022-12-01
Provider Licenses
StateLicense IDTaxonomies
NY025551-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist