MEDICARE: MS. DELALI ABLA GOKA PT, DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	263191	NY

General Provider Information

NPI Number	:	1326264375
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DELALI ABLA GOKA PT, DPT

Provider Business Mailing Address
First Line	:	1 LANDMARK SQ
Second Line	:	#410
City	:	PORT CHESTER
State	:	NY
Zip	:	10573-3348
Country	:	US
Telephone Number	:	914-939-0050
Fax Number	:

Provider Business Practice Location Address
First Line	:	333 MAMARONECK AVE
Second Line	:	#331
City	:	WHITE PLAINS
State	:	NY
Zip	:	10605-1440
Country	:	US
Telephone Number	:	914-458-2249
Fax Number	:	914-885-1072

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/18/2007
Last Update Date	:	10/22/2012

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