Individual
LEO MIROCHNIK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
1351 FOREST AVE, STATEN ISLAND, NY 10302-2049
(917) 722-6883
Mailing address
21 ARDEN AVE, STATEN ISLAND, NY 10312-1206
(646) 593-1417
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
014055
NY
Other
Enumeration date
12/01/2023
Last updated
12/01/2023
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