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Organization
FRUITION PHYSICAL THERAPY PLLC
Active
Organization
FRUITION PHYSICAL THERAPY PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ODE EGHAREVBA (OWNER)
(347) 869-9798
Entity
Organization
Contact information
Practice address
2747 CRESCENT ST STE 203, ASTORIA, NY 11102-3142
(347) 869-9798
Mailing address
100 BROADWAY UNIT 594, LYNBROOK, NY 11563-5013
(347) 869-9798
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Enumeration date
05/19/2021
Last updated
11/16/2021
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