Healthcare Provider Details

I. General information

NPI: 1922046655
Provider Name (Legal Business Name): HANDS-ON PHYSICAL THERAPY OF BAYSIDE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 07/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20801 NORTHERN BLVD FL 3
BAYSIDE NY
11361-3151
US

IV. Provider business mailing address

3270 31ST ST
ASTORIA NY
11106-2643
US

V. Phone/Fax

Practice location:
  • Phone: 718-707-6970
  • Fax: 718-707-6977
Mailing address:
  • Phone: 718-707-6970
  • Fax: 718-707-6977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number011188
License Number StateNY

VIII. Authorized Official

Name: MR. KONSTANTINE RIZOPOULOS
Title or Position: CO-OWNER
Credential: PT
Phone: 718-626-2699