Provider Demographics
NPI:1114308756
Name:ALLURE PHYSICAL THERAPY P.C.
Entity type:Organization
Organization Name:ALLURE PHYSICAL THERAPY P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:YAN
Authorized Official - Middle Name:
Authorized Official - Last Name:YUSUPOV
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:917-757-6307
Mailing Address - Street 1:9735 63RD DR
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-2229
Mailing Address - Country:US
Mailing Address - Phone:917-757-6307
Mailing Address - Fax:
Practice Address - Street 1:1894 EASTCHESTER RD
Practice Address - Street 2:SUITE 204
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-2328
Practice Address - Country:US
Practice Address - Phone:917-708-9181
Practice Address - Fax:917-708-9182
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-09
Last Update Date:2015-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031272225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty