Provider Demographics
NPI:1558908459
Name:OPOKA, ELIZABETH S (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:S
Last Name:OPOKA
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:DR
Other - First Name:LIZ
Other - Middle Name:S
Other - Last Name:OPOKA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:433 7TH AVE APT 4
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-7310
Mailing Address - Country:US
Mailing Address - Phone:917-586-3894
Mailing Address - Fax:
Practice Address - Street 1:113 W 78TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-6755
Practice Address - Country:US
Practice Address - Phone:212-579-2858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-10
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY036526-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist