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Organization
STAY ACTIVE PHYSICAL THERAPY, PLLC
Active
Organization
STAY ACTIVE PHYSICAL THERAPY, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALEXANDER AKSANOV DPT (PRESIDENT)
(917) 915-3894
Entity
Organization
Contact information
Practice address
297 BAY 20TH ST APT 2, BROOKLYN, NY 11214-6011
(917) 915-3894
Mailing address
9322 3RD AVE STE 476, BROOKLYN, NY 11209-6802
(917) 915-3894
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0444489
UNIVERSITY OF THE STATE OF NEW YORK, PHYSICAL THERAPIST
NY
Enumeration date
03/10/2020
Last updated
03/10/2020
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