Healthcare Provider Details

I. General information

NPI: 1306263363
Provider Name (Legal Business Name): BRONX PHYSICAL THERAPY AND REHABILITATION PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2014
Last Update Date: 05/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

984 MORRIS PARK AVE
BRONX NY
10462-3714
US

IV. Provider business mailing address

984 MORRIS PARK AVE
BRONX NY
10462-3714
US

V. Phone/Fax

Practice location:
  • Phone: 718-823-7676
  • Fax: 718-823-7675
Mailing address:
  • Phone: 718-823-7676
  • Fax: 718-823-7675

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number011119
License Number StateNY

VIII. Authorized Official

Name: MR. SAMUEL IGNACIO
Title or Position: PHYSICAL THERAPIST
Credential: PT
Phone: 718-823-7676