Healthcare Provider Details

I. General information

NPI: 1669898284
Provider Name (Legal Business Name): FLEX CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2014
Last Update Date: 06/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 SHERMAN POTTS DR SUITE 202
GHENT NY
12075-3216
US

IV. Provider business mailing address

2 SHERMAN POTTS DR SUITE 202
GHENT NY
12075-3216
US

V. Phone/Fax

Practice location:
  • Phone: 518-965-6099
  • Fax:
Mailing address:
  • Phone: 518-965-6099
  • Fax: 518-822-0776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number028416
License Number StateNY

VIII. Authorized Official

Name: IJUNANYA HOLDER
Title or Position: DIRECTOR/PHYSICAL THERAPIST
Credential:
Phone: 518-965-6099