Healthcare Provider Details

I. General information

NPI: 1548449549
Provider Name (Legal Business Name): FUNCTION ENHANCING PHYSICAL THERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27-10 ASTORIA BLVD GROUND FLOOR
ASTORIA NY
11102
US

IV. Provider business mailing address

2710 ASTORIA BLVD
ASTORIA NY
11102-4358
US

V. Phone/Fax

Practice location:
  • Phone: 718-545-8877
  • Fax: 718-545-8879
Mailing address:
  • Phone: 718-545-8877
  • Fax: 718-545-8879

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number024863-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: NICOLAOS SPIRATOS
Title or Position: PRESIDENT
Credential: PT
Phone: 718-545-8877