Provider Demographics
NPI:1669773701
Name:ARISTA PHYSICAL THERAPY WELLNESS PLLC
Entity type:Organization
Organization Name:ARISTA PHYSICAL THERAPY WELLNESS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KOSTA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOKOLIS
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:187-777-2244
Mailing Address - Street 1:6 E 45TH ST FL 18
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-2401
Mailing Address - Country:US
Mailing Address - Phone:212-529-5700
Mailing Address - Fax:
Practice Address - Street 1:30-16 30TH DRIVE
Practice Address - Street 2:2ND FLR
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11102-1890
Practice Address - Country:US
Practice Address - Phone:718-777-2244
Practice Address - Fax:718-777-2254
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-05
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty