Healthcare Provider Details

I. General information

NPI: 1699652743
Provider Name (Legal Business Name): JOSE MANUEL GAA LANZONA PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2025
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

741 MANHATTAN AVE
BROOKLYN NY
11222-6233
US

IV. Provider business mailing address

102 MADISON AVE FL 8
NEW YORK NY
10016-7584
US

V. Phone/Fax

Practice location:
  • Phone: 646-347-0015
  • Fax: 212-379-2123
Mailing address:
  • Phone: 212-759-2282
  • Fax: 212-379-2123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number054556
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: