Healthcare Provider Details

I. General information

NPI: 1255637559
Provider Name (Legal Business Name): JMP PHYSICAL THERAPY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2011
Last Update Date: 02/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15705 CROSSBAY BLVD
HOWARD BEACH NY
11414-2748
US

IV. Provider business mailing address

157- 05 CROSSBAY BLVD.
HOWARD BEACH NY
11414
US

V. Phone/Fax

Practice location:
  • Phone: 718-641-8700
  • Fax: 718-641-8702
Mailing address:
  • Phone: 718-641-8700
  • Fax: 718-641-8702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number027737
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. JOHN PANTALEO
Title or Position: PRESIDENT/ OWNER
Credential: DPT
Phone: 718-641-8700