Provider Demographics
NPI:1588064901
Name:GEORGE, PREETH (PT)
Entity type:Individual
Prefix:MR
First Name:PREETH
Middle Name:
Last Name:GEORGE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8821 219TH ST
Mailing Address - Street 2:
Mailing Address - City:QUEENS VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11427-2016
Mailing Address - Country:US
Mailing Address - Phone:646-725-2532
Mailing Address - Fax:646-725-2532
Practice Address - Street 1:8821 219TH ST
Practice Address - Street 2:
Practice Address - City:QUEENS VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11427-2016
Practice Address - Country:US
Practice Address - Phone:646-725-2532
Practice Address - Fax:718-465-5918
Is Sole Proprietor?:No
Enumeration Date:2014-09-04
Last Update Date:2014-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY037790225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist