Healthcare Provider Details

I. General information

NPI: 1447336193
Provider Name (Legal Business Name): BRONX PHYSICAL THERAPY, LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 03/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3611 E TREMONT AVE
BRONX NY
10465-2009
US

IV. Provider business mailing address

3611 E TREMONT AVE
BRONX NY
10465-2009
US

V. Phone/Fax

Practice location:
  • Phone: 718-904-9581
  • Fax: 718-931-0125
Mailing address:
  • Phone: 718-904-9581
  • Fax: 718-931-0125

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number006745-1
License Number StateNY

VIII. Authorized Official

Name: EDWARD BLUM
Title or Position: OWNER
Credential: P.T.
Phone: 718-904-9581