Provider Demographics
NPI:1639798978
Name:GAYLA, RAYMOND REYES (PT DPT)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:REYES
Last Name:GAYLA
Suffix:
Gender:M
Credentials:PT DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9243 51ST AVE BSMT
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-4013
Mailing Address - Country:US
Mailing Address - Phone:347-585-8145
Mailing Address - Fax:
Practice Address - Street 1:9243 51ST AVE BSMT
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-4013
Practice Address - Country:US
Practice Address - Phone:347-585-8145
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-15
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040489-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist