Provider Demographics
NPI:1750622957
Name:YAGHOUBI, GINA SARAH (DPT)
Entity type:Individual
Prefix:DR
First Name:GINA
Middle Name:SARAH
Last Name:YAGHOUBI
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:118 SIWANOY BLVD
Mailing Address - Street 2:
Mailing Address - City:EASTCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:10709-3815
Mailing Address - Country:US
Mailing Address - Phone:914-395-3290
Mailing Address - Fax:914-395-0247
Practice Address - Street 1:2150 CENTRAL PARK AVE
Practice Address - Street 2:SUITE 207
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10710-1856
Practice Address - Country:US
Practice Address - Phone:914-395-3290
Practice Address - Fax:914-395-0247
Is Sole Proprietor?:No
Enumeration Date:2013-03-13
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY035687-1225100000X, 2251G0304X, 2251N0400X, 2251S0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics
No2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports