Most Relevant Information
Provider Data
| NPI Number: | 1003419896 |
| Provider Name: | THARA KRISTELLE ENERIO PT |
| Entity Type: | Individual |
| Taxonomy Code: | 208100000X |
| Specialty: | Physical Medicine & Rehabilitation |
| License Number: | 043504-1 |
Most Important Dates
| Enumeration Date: | 11/16/2020 |
| Last Updated: | 11/16/2020 |
Provider Practice Location
26717 HILLSIDE AVE
GLEN OAKS
NY
110041743
Practice Location Phone/Fax
| Phone: | 7183432121 |
| Fax: |
Provider Mailing Location
3433 62ND ST
WOODSIDE
NY
113772147
Provider Mailing Phone/Fax
| Phone: | 9084163155 |
| Fax: |