Provider Demographics
NPI:1356631394
Name:LOSQUADRO, JON (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:
Last Name:LOSQUADRO
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 COYLE ST
Mailing Address - Street 2:#207
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-1747
Mailing Address - Country:US
Mailing Address - Phone:917-640-4499
Mailing Address - Fax:
Practice Address - Street 1:2800 COYLE ST
Practice Address - Street 2:#207
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-1747
Practice Address - Country:US
Practice Address - Phone:917-640-4499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-11
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033556225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist