Healthcare Provider Details

I. General information

NPI: 1659355956
Provider Name (Legal Business Name): NY PHYSICAL THERAPY & WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2005
Last Update Date: 12/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 HEMPSTEAD TPKE
FRANKLIN SQUARE NY
11010-4342
US

IV. Provider business mailing address

820 HEMPSTEAD TPKE
FRANKLIN SQUARE NY
11010-4342
US

V. Phone/Fax

Practice location:
  • Phone: 516-358-8911
  • Fax: 516-358-8960
Mailing address:
  • Phone: 516-358-8911
  • Fax: 516-358-8960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. MARK ANTHONY DIAZ
Title or Position: PHYSICAL THERAPIST OWNER
Credential: PT
Phone: 516-358-8911