Provider Demographics
NPI:1356193163
Name:YAKUTILOVA, RAYA
Entity type:Individual
Prefix:
First Name:RAYA
Middle Name:
Last Name:YAKUTILOVA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BISHOP ORRIS G. WALKER, JR HEALTHCARE CENTER
Mailing Address - Street 2:528 PROSPECT PLACE, 3RD FLOOR SUITE A
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11238
Mailing Address - Country:US
Mailing Address - Phone:718-613-6908
Mailing Address - Fax:718-228-7064
Practice Address - Street 1:BISHOP ORRIS G. WALKER, JR HEALTHCARE CENTER
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11238
Practice Address - Country:US
Practice Address - Phone:718-613-6908
Practice Address - Fax:718-228-7064
Is Sole Proprietor?:No
Enumeration Date:2024-04-04
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant