Provider Demographics
NPI:1235238999
Name:GAGLIAS, XRISTOS K (ATC)
Entity type:Individual
Prefix:MR
First Name:XRISTOS
Middle Name:K
Last Name:GAGLIAS
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:21 RIDGE HAVEN DR
Mailing Address - Street 2:
Mailing Address - City:RIDGE
Mailing Address - State:NY
Mailing Address - Zip Code:11961-2127
Mailing Address - Country:US
Mailing Address - Phone:631-632-7255
Mailing Address - Fax:631-632-7210
Practice Address - Street 1:STONY BROOK UNIVERSITY
Practice Address - Street 2:SPORTS COMPLEX
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-3504
Practice Address - Country:US
Practice Address - Phone:631-632-7255
Practice Address - Fax:631-632-7210
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY000869-12255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer