Provider Demographics
NPI:1841681236
Name:GEALON, ROEHL (PT)
Entity type:Individual
Prefix:MR
First Name:ROEHL
Middle Name:
Last Name:GEALON
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 1:100 BELLAMY LOOP APT 24F
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10475-3747
Mailing Address - Country:US
Mailing Address - Phone:718-684-3479
Mailing Address - Fax:
Practice Address - Street 1:100 BELLAMY LOOP APT 24F
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10475-3747
Practice Address - Country:US
Practice Address - Phone:718-684-3479
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-07
Last Update Date:2015-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY036190225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist