Provider Demographics
NPI:1780400648
Name:BOUZAGLOU, GABRIELA (DPT)
Entity type:Individual
Prefix:
First Name:GABRIELA
Middle Name:
Last Name:BOUZAGLOU
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1206 WASHINGTON ST APT 4
Mailing Address - Street 2:
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-5456
Mailing Address - Country:US
Mailing Address - Phone:818-723-7998
Mailing Address - Fax:
Practice Address - Street 1:55 BROADWAY STE 201
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10006-3759
Practice Address - Country:US
Practice Address - Phone:646-870-5440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-25
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY053488225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist