Healthcare Provider Details

I. General information

NPI: 1043521396
Provider Name (Legal Business Name): NATALLIA HUTMAN DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2010
Last Update Date: 09/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1855 RICHMOND AVE STE 104
STATEN ISLAND NY
10314-3912
US

IV. Provider business mailing address

1855 RICHMOND AVE STE 104
STATEN ISLAND NY
10314-3912
US

V. Phone/Fax

Practice location:
  • Phone: 718-880-8571
  • Fax: 718-556-7868
Mailing address:
  • Phone: 718-880-8571
  • Fax: 718-556-7868

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number19068
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number035024
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: