Provider Demographics
NPI:1194052878
Name:VIROLA, ALVIN (RPT)
Entity type:Individual
Prefix:MR
First Name:ALVIN
Middle Name:
Last Name:VIROLA
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8531 LEFFERTS BLVD
Mailing Address - Street 2:
Mailing Address - City:KEW GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11415-3003
Mailing Address - Country:US
Mailing Address - Phone:206-617-2216
Mailing Address - Fax:
Practice Address - Street 1:460 GRAND ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10002-4058
Practice Address - Country:US
Practice Address - Phone:212-539-0257
Practice Address - Fax:212-677-4853
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-17
Last Update Date:2009-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029497225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist