Great Western Physical Therapy PC

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

Legal business name

GREAT WESTERN PHYSICAL THERAPY PC

Practice address

3175 29TH St Apt A7
Astoria, NY 11106-3328

Phone

(929) 340-1606

NPI assigned

Jan 3, 2020

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Mark Davydov, DPT

Title

Physical Therapist

Phone

(929) 340-1606

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1578009600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1578009600000",
    "number": "1174162440",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3175 29TH ST APT A7",
            "city": "ASTORIA",
            "state": "NY",
            "postal_code": "111063328",
            "telephone_number": "929-340-1606"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3175 29TH ST APT A7",
            "city": "ASTORIA",
            "state": "NY",
            "postal_code": "111063328",
            "telephone_number": "929-340-1606"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT WESTERN PHYSICAL THERAPY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-01-03",
        "last_updated": "2020-01-03",
        "certification_date": "2020-01-03",
        "status": "A",
        "authorized_official_last_name": "DAVYDOV",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "929-340-1606",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Valerie Graf, LCSW
• Tamicka Grant, RN
• Terry Gravesande, RPA
• Elizabeth Gray
• Great Neck Acupuncturist & Wellness, PC
• Greater New York Gastroenterology, LLP
• Andrea Greco, LCSW
• Evelyn Greco, DO
• Krista Marie Green
• Paula Gregoriades

• Physical Therapy Clinic/Center in Astoria, NY
• Providers in Astoria, NY by specialty
• Physical Therapy Clinic/Center in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.