Provider Demographics
NPI:1447585880
Name:GLORIA, MICHAEL TRISTRAM CURAMENG (PT)
Entity type:Individual
Prefix:
First Name:MICHAEL TRISTRAM
Middle Name:CURAMENG
Last Name:GLORIA
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 1:3709 62ND ST
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-2622
Mailing Address - Country:US
Mailing Address - Phone:917-340-6566
Mailing Address - Fax:
Practice Address - Street 1:3709 62ND ST
Practice Address - Street 2:
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-2622
Practice Address - Country:US
Practice Address - Phone:917-340-6566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-02
Last Update Date:2009-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026618225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist