Healthcare Provider Details

I. General information

NPI: 1982880415
Provider Name (Legal Business Name): MEDINA FITNESS & REHAB, P.T. P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2008
Last Update Date: 01/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5912 RIVERDALE AVE
BRONX NY
10471-1603
US

IV. Provider business mailing address

5912 RIVERDALE AVE
BRONX NY
10471-1603
US

V. Phone/Fax

Practice location:
  • Phone: 347-275-9044
  • Fax: 347-602-5287
Mailing address:
  • Phone: 347-275-9044
  • Fax: 347-602-5287

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number026258
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2251H1200X
TaxonomyHand Physical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State
# 8
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number StateNY

VIII. Authorized Official

Name: MS. ELIZABETH MEDINA
Title or Position: PHYSICAL THERAPIST/OWNER
Credential: MS PT
Phone: 347-275-9044