Provider Demographics
NPI:1386155570
Name:ARIAS, FERNANDO (PTA)
Entity type:Individual
Prefix:
First Name:FERNANDO
Middle Name:
Last Name:ARIAS
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5963 60TH LN FL 1
Mailing Address - Street 2:
Mailing Address - City:MASPETH
Mailing Address - State:NY
Mailing Address - Zip Code:11378-3448
Mailing Address - Country:US
Mailing Address - Phone:646-287-9648
Mailing Address - Fax:
Practice Address - Street 1:12 W 21ST ST FL 2
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-6917
Practice Address - Country:US
Practice Address - Phone:646-484-5763
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-16
Last Update Date:2017-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007418225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant