Provider Demographics
NPI:1427483825
Name:CIVIL, CLIFFORD (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:CLIFFORD
Middle Name:
Last Name:CIVIL
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 CLARKSON AVE APT 208
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-2999
Mailing Address - Country:US
Mailing Address - Phone:347-815-5228
Mailing Address - Fax:
Practice Address - Street 1:310 CLARKSON AVE APT 208
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-2999
Practice Address - Country:US
Practice Address - Phone:347-815-5228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-05
Last Update Date:2019-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY036702-12251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic