Most Relevant Information
Provider Data
| NPI Number: | 1003682808 |
| Provider Name: | LEO MIROCHNIK PTA |
| Entity Type: | Individual |
| Taxonomy Code: | 225200000X |
| Specialty: | Physical Therapy Assistant |
| License Number: | 014055 |
Most Important Dates
| Enumeration Date: | 12/01/2023 |
| Last Updated: | 12/01/2023 |
Provider Practice Location
1351 FOREST AVE
STATEN ISLAND
NY
103022049
Practice Location Phone/Fax
| Phone: | 9177226883 |
| Fax: |
Provider Mailing Location
21 ARDEN AVE
STATEN ISLAND
NY
103121206
Provider Mailing Phone/Fax
| Phone: | 6465931417 |
| Fax: |