Provider Demographics
NPI:1295871960
Name:PADOR, TRISTAN NOEL OLIVA (PT)
Entity type:Individual
Prefix:MR
First Name:TRISTAN NOEL
Middle Name:OLIVA
Last Name:PADOR
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:21203 75TH AVE
Mailing Address - Street 2:APARTMENT 6F
Mailing Address - City:OAKLAND GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11364-3359
Mailing Address - Country:US
Mailing Address - Phone:516-314-4769
Mailing Address - Fax:718-464-0520
Practice Address - Street 1:21203 75TH AVE
Practice Address - Street 2:APARTMENT 6F
Practice Address - City:OAKLAND GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11364-3359
Practice Address - Country:US
Practice Address - Phone:516-314-4769
Practice Address - Fax:718-464-0520
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020392-1225100000X
IN05006051A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist