Provider Demographics
NPI:1396943577
Name:KHOTYLEV, BORIS (PT)
Entity type:Individual
Prefix:
First Name:BORIS
Middle Name:
Last Name:KHOTYLEV
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 1:1806 VOORHIES AVE, APT 3B
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-3648
Mailing Address - Country:US
Mailing Address - Phone:718-427-0362
Mailing Address - Fax:
Practice Address - Street 1:2126 BENSON AVE APT 5H
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-5033
Practice Address - Country:US
Practice Address - Phone:347-673-6817
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-10
Last Update Date:2015-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics