Provider Demographics
NPI:1376278234
Name:OLVIDO, GIORLAN SOSOSCO (PT)
Entity Type:Individual
Prefix:
First Name:GIORLAN
Middle Name:SOSOSCO
Last Name:OLVIDO
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 1:4020 67TH ST
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-8525
Mailing Address - Country:US
Mailing Address - Phone:646-387-0769
Mailing Address - Fax:
Practice Address - Street 1:4020 67TH ST
Practice Address - Street 2:
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-8525
Practice Address - Country:US
Practice Address - Phone:646-387-0769
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-22
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046392225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty