Provider Demographics
NPI:1558907188
Name:ARRIOLA, JASMYNN GONZALES (PT)
Entity Type:Individual
Prefix:
First Name:JASMYNN
Middle Name:GONZALES
Last Name:ARRIOLA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:JASMYNN
Other - Middle Name:ARRIOLA
Other - Last Name:AMADORA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:1780 W 3RD ST APT L8
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-1526
Mailing Address - Country:US
Mailing Address - Phone:917-929-7609
Mailing Address - Fax:
Practice Address - Street 1:2133 RALPH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-5405
Practice Address - Country:US
Practice Address - Phone:718-451-1400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-19
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040195225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist