Provider Demographics
NPI:1124877576
Name:PAVAI, PRISCILLA (PT)
Entity type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:
Last Name:PAVAI
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 1:8 RUMFORD RD
Mailing Address - Street 2:
Mailing Address - City:KINGS PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11754-4110
Mailing Address - Country:US
Mailing Address - Phone:609-592-8117
Mailing Address - Fax:
Practice Address - Street 1:234 ORINOCO DRIVE
Practice Address - Street 2:
Practice Address - City:BRIGHTWATERS
Practice Address - State:NY
Practice Address - Zip Code:11718
Practice Address - Country:US
Practice Address - Phone:631-300-0797
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-17
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY051759225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist