Individual
GIGA GAMBASHIDZE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1556 W 8TH ST, APT 2, BROOKLYN, NY 11204
(646) 379-0072
Mailing address
1556 W 8TH ST APT 2, BROOKLYN, NY 11204-6503
(646) 379-0072
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
010829-1
NY
Other
Enumeration date
10/30/2017
Last updated
10/30/2017
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