Provider Demographics
NPI:1730991738
Name:THAKOR, ALEX (PT)
Entity type:Individual
Prefix:
First Name:ALEX
Middle Name:
Last Name:THAKOR
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 1:166 DIVISION AVE
Mailing Address - Street 2:
Mailing Address - City:HICKSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11801-4828
Mailing Address - Country:US
Mailing Address - Phone:516-979-5678
Mailing Address - Fax:
Practice Address - Street 1:20 W LINCOLN AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580-5731
Practice Address - Country:US
Practice Address - Phone:516-825-1112
Practice Address - Fax:516-256-0503
Is Sole Proprietor?:No
Enumeration Date:2025-01-25
Last Update Date:2025-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP131903225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist