Provider Demographics
NPI:1801833348
Name:IAVARONE, THOMAS CHARLES (PT)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:CHARLES
Last Name:IAVARONE
Suffix:
Gender:M
Credentials:PT
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Mailing Address - Street 1:3935 51ST ST
Mailing Address - Street 2:APT 4F
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-3152
Mailing Address - Country:US
Mailing Address - Phone:718-606-9733
Mailing Address - Fax:631-467-0928
Practice Address - Street 1:20 PEACHTREE CT
Practice Address - Street 2:#105
Practice Address - City:HOLBROOK
Practice Address - State:NY
Practice Address - Zip Code:11741-4616
Practice Address - Country:US
Practice Address - Phone:631-467-3700
Practice Address - Fax:631-467-0928
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY011563-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist