Healthcare Provider Details

I. General information

NPI: 1154445948
Provider Name (Legal Business Name): HOME CARE PHYSICAL THERAPY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 10/21/2021
Certification Date: 10/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6649 MARBELLA LN
NAPLES FL
34105-5048
US

IV. Provider business mailing address

6649 MARBELLA LN
NAPLES FL
34105-5048
US

V. Phone/Fax

Practice location:
  • Phone: 914-844-7537
  • Fax:
Mailing address:
  • Phone: 914-844-7537
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number010548-1
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number010548-1
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number010548-1
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code320700000X
TaxonomyPhysical Disabilities Residential Treatment Facility
License Number010548-1
License Number StateNY

VIII. Authorized Official

Name: MR. RICO KINTANAR SABULAO
Title or Position: PRESIDENT
Credential: P.T.
Phone: 914-844-7537