Provider Demographics
NPI:1306123047
Name:KRAVCHENKO, ROZA (PTA)
Entity type:Individual
Prefix:
First Name:ROZA
Middle Name:
Last Name:KRAVCHENKO
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1469 BAY RIDGE PKWY
Mailing Address - Street 2:APT. 1B
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11228-2223
Mailing Address - Country:US
Mailing Address - Phone:917-392-2778
Mailing Address - Fax:
Practice Address - Street 1:1220 AVENUE P
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-1009
Practice Address - Country:US
Practice Address - Phone:718-376-1004
Practice Address - Fax:718-376-1150
Is Sole Proprietor?:No
Enumeration Date:2011-11-09
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0038451225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant