Healthcare Provider Details

I. General information

NPI: 1720754237
Provider Name (Legal Business Name): FONTANEZ PHYSICAL THERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2021
Last Update Date: 08/30/2024
Certification Date: 08/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

422 BEACH 64TH ST
ARVERNE NY
11692-1423
US

IV. Provider business mailing address

422 BEACH 64TH ST
ARVERNE NY
11692-1423
US

V. Phone/Fax

Practice location:
  • Phone: 646-737-4728
  • Fax:
Mailing address:
  • Phone: 646-737-4728
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. PEDRO M. FONTANEZ
Title or Position: PHYSICAL THERAPIST/ PRESIDENT
Credential: PT, DPT
Phone: 646-737-4728