Individual
MR. JIVAN RAY LEONIDA RESANO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
9128 PARK LN S, WOODHAVEN, NY 11421-1432
(808) 342-4208
Mailing address
9128 PARK LN S, WOODHAVEN, NY 11421-1432
(808) 342-4208
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
014020
NY
Other
Enumeration date
12/11/2023
Last updated
12/11/2023
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