Healthcare Provider Details

I. General information

NPI: 1891220968
Provider Name (Legal Business Name): MGH PHYSICAL THERAPY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2017
Last Update Date: 07/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14428 34TH AVE
FLUSHING NY
11354-3127
US

IV. Provider business mailing address

14428 34TH AVE
FLUSHING NY
11354-3127
US

V. Phone/Fax

Practice location:
  • Phone: 917-578-3337
  • Fax:
Mailing address:
  • Phone: 917-578-3337
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: MR. MARIOS HARITOS
Title or Position: OWNER
Credential: PT
Phone: 917-578-3337