Provider Demographics
NPI:1760571095
Name:PETRILYAK, GERALYN MARY (PT)
Entity Type:Individual
Prefix:MS
First Name:GERALYN
Middle Name:MARY
Last Name:PETRILYAK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:245 5TH AVE
Mailing Address - Street 2:1ST FL.
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-8728
Mailing Address - Country:US
Mailing Address - Phone:646-935-2266
Mailing Address - Fax:646-935-2274
Practice Address - Street 1:245 5TH AVE
Practice Address - Street 2:1ST FL.
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-8728
Practice Address - Country:US
Practice Address - Phone:646-935-2266
Practice Address - Fax:646-935-2274
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY015997225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist