Provider Demographics
NPI:1790854362
Name:NESTOR, SLAVA (PT)
Entity Type:Individual
Prefix:MRS
First Name:SLAVA
Middle Name:
Last Name:NESTOR
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10124 QUEENS BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-2703
Mailing Address - Country:US
Mailing Address - Phone:718-261-8881
Mailing Address - Fax:718-261-8889
Practice Address - Street 1:1725 E 12TH ST STE 501
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-1067
Practice Address - Country:US
Practice Address - Phone:718-261-8881
Practice Address - Fax:718-261-8889
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM026503225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist