Provider Demographics
NPI:1962097618
Name:FATAKHOVA, ALINA (PT, DPT)
Entity type:Individual
Prefix:
First Name:ALINA
Middle Name:
Last Name:FATAKHOVA
Suffix:
Gender:F
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 1:202 UNION AVE STE K
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11211-7467
Mailing Address - Country:US
Mailing Address - Phone:718-387-7420
Mailing Address - Fax:718-387-7421
Practice Address - Street 1:202 UNION AVE STE K
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11211-7467
Practice Address - Country:US
Practice Address - Phone:718-387-7420
Practice Address - Fax:718-387-7421
Is Sole Proprietor?:No
Enumeration Date:2021-03-04
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY043158-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist