Healthcare Provider Details

I. General information

NPI: 1376917484
Provider Name (Legal Business Name): KRISTIN AREVALO ASSOCIATES DEGREE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2015
Last Update Date: 12/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

72 S WOODS RD
WOODBURY NY
11797-1024
US

IV. Provider business mailing address

150 N BROOME AVE
LINDENHURST NY
11757-4130
US

V. Phone/Fax

Practice location:
  • Phone: 516-921-7650
  • Fax:
Mailing address:
  • Phone: 516-477-9456
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number010109-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: