Provider Demographics
NPI:1508466848
Name:GADOR, JOPHEL (PT)
Entity Type:Individual
Prefix:
First Name:JOPHEL
Middle Name:
Last Name:GADOR
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3153 34TH ST APT 3E
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11106-1710
Mailing Address - Country:US
Mailing Address - Phone:804-300-1407
Mailing Address - Fax:
Practice Address - Street 1:2710 ASTORIA BLVD STE 1
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11102-1962
Practice Address - Country:US
Practice Address - Phone:718-545-8877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-27
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046060225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist