Provider Demographics
NPI:1780628883
Name:FLETCHER, JOHN GIL (PT)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:GIL
Last Name:FLETCHER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1911 RICHMOND AVE
Mailing Address - Street 2:SUITE 130
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-3913
Mailing Address - Country:US
Mailing Address - Phone:718-982-6496
Mailing Address - Fax:718-982-6751
Practice Address - Street 1:1911 RICHMOND AVE
Practice Address - Street 2:SUITE 130
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-3913
Practice Address - Country:US
Practice Address - Phone:718-982-6496
Practice Address - Fax:718-982-6751
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003318225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ50232Medicare ID - Type UnspecifiedMEDICARE ID