Healthcare Provider Details

I. General information

NPI: 1528215738
Provider Name (Legal Business Name): BRONX DEKALB PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2008
Last Update Date: 09/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3435 DEKALB AVE
BRONX NY
10467-2301
US

IV. Provider business mailing address

3435 DEKALB AVE
BRONX NY
10467-2301
US

V. Phone/Fax

Practice location:
  • Phone: 718-547-8899
  • Fax:
Mailing address:
  • Phone: 718-547-8899
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number013814-1
License Number StateNY

VIII. Authorized Official

Name: MRS. MA.ANELYN C. SUAZO
Title or Position: PHYSICAL THERAPIST
Credential: PT
Phone: 845-309-3163