Provider Demographics
NPI:1205160033
Name:CHARRIS, JOAQUIN (PT)
Entity type:Individual
Prefix:
First Name:JOAQUIN
Middle Name:
Last Name:CHARRIS
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 1:8131 BAXTER AVE
Mailing Address - Street 2:SUITE CD
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-1315
Mailing Address - Country:US
Mailing Address - Phone:718-424-5151
Mailing Address - Fax:718-424-9119
Practice Address - Street 1:8131 BAXTER AVE
Practice Address - Street 2:SUITE CD
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-1315
Practice Address - Country:US
Practice Address - Phone:718-424-5151
Practice Address - Fax:718-424-9119
Is Sole Proprietor?:No
Enumeration Date:2009-09-26
Last Update Date:2012-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026983225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist